Antimicrobial compounds, compositions, and uses thereof

ABSTRACT

A method of treating an infection of at least one of a wound or a ulcer in a patient in need thereof according to an embodiment includes administering to the patient an effective amount of a compound having the formula: 
                         
or a pharmaceutically acceptable salt thereof.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 16/941,627 filed Jul. 29, 2020, which is a continuation of U.S.patent application Ser. No. 16/505,497 filed Jul. 8, 2019 and issued asU.S. Pat. No. 10,752,651, which is a continuation of U.S. patentapplication Ser. No. 15/919,138 filed Mar. 12, 2018, which claimspriority to U.S. Provisional Patent Application Ser. Nos. 62/470,025 and62/470,039 filed on Mar. 10, 2017, each of which is incorporated byreference herein in its entirety.

FIELD

The present disclosure provides novel antimicrobial compounds andcompositions and uses thereof.

BACKGROUND

Bisphosphocin® compounds have antimicrobial activity. U.S. Pat. No.7,868,162 discloses Bisphosphocin® compounds.

SUMMARY

The present disclosure provides a method of treating an infection of atleast one of a wound or an ulcer in a patient in need thereof. Themethod may include administering to the patient an effective amount of acompound having the formula:

or a pharmaceutically acceptable salt thereof.

In some embodiments, the administration may be topical administration.

In some embodiments, the administration may be carried out using thecompound, or a pharmaceutically acceptable salt thereof, in a lotion,paste, gel, cream, ointment, oil, or other viscous composition.

In some embodiments, the administration may be carried out using thecompound, or a pharmaceutically acceptable salt thereof, in a powder,solution, or suspension.

In some embodiments, the patient may be administered at least oneadditional active ingredient.

In some embodiments, the administration may be carried out as a multipledose regimen.

In some embodiments, the multiple dose regimen may be a time period ofup to about 7 days.

In some embodiments, the multiple dose regimen may be a time period ofup to about 14 days.

In some embodiments, the multiple dose regimen may be a time period ofup to about 21 days or up to about one month.

In some embodiments, the administration may be carried out as a chronictreatment regimen.

In some embodiments, the administration may be carried out one or moretimes per day.

In some embodiments, the amount of the compound, or a pharmaceuticallyacceptable salt thereof, administered to the patient may be from about0.1 to about 1000 milligram (mg) of the compound, or a pharmaceuticallyacceptable salt thereof, per kilogram (kg) of patient body weight.

In some embodiments, the amount of the compound, or a pharmaceuticallyacceptable salt thereof, administered to the patient may be from about0.1 to about 500 mg of the compound, or a pharmaceutically acceptablesalt thereof, per kg of patient body weight.

In some embodiments, the amount of the compound, or a pharmaceuticallyacceptable salt thereof, administered to the patient may be from about0.1 to about 300 mg of the compound, or a pharmaceutically acceptablesalt thereof, per kg of patient body weight.

In some embodiments, the amount of the compound, or a pharmaceuticallyacceptable salt thereof, administered to the patient may be from about0.1 to about 200 mg of the compound, or a pharmaceutically acceptablesalt thereof, per kg of patient body weight.

In some embodiments, the amount of the compound, or a pharmaceuticallyacceptable salt thereof, administered to the patient may be from about0.1 to about 100 mg of the compound, or a pharmaceutically acceptablesalt thereof, per kg of patient body weight.

In some embodiments, the patient may be a human.

In some embodiments, the pharmaceutically acceptable salt may be asodium salt.

In some embodiments, the sodium salt may be sodium((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methy1 butyl phosphate.

In some embodiments, the wound may be a burn wound.

In some embodiments, the ulcer may be a diabetic foot ulcer.

Additional aspects and embodiments will be apparent from the DetailedDescription and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The concepts described herein are illustrative by way of example and notby way of limitation in the accompanying figures. For simplicity andclarity of illustration, elements illustrated in the figures are notnecessarily drawn to scale.

FIG. 1 shows a decrease in CFU burden (in thousands) for mice treatedwith Nu-8 forumlated in saline solution or Nu-8 formulated in hydrogelcompared to control according to an embodiment.

FIG. 2 shows a decrease in CFU burden (in log value) for mice treatedwith Nu-8 forumlated in saline solution or Nu-8 formulated in hydrogelcompared to control according to an embodiment.

FIG. 3 shows a decrease in CFU burden (in residual percentage) for micetreated with Nu-8 forumlated in saline solution or Nu-8 formulated inhydrogel compared to control according to an embodiment.

DETAILED DESCRIPTION

The embodiments described below are not intended to be exhaustive or tolimit the invention to the precise forms disclosed in the followingdetailed description. Rather, the embodiments are chosen and describedso that others skilled in the art may appreciate and understand theprinciples and practices of this disclosure.

References in the specification to “one embodiment,” “an embodiment,”“an illustrative embodiment,” etc., indicate that the embodimentdescribed may include a particular feature, structure, orcharacteristic, but every embodiment may or may not necessarily includethat particular feature, structure, or characteristic. Moreover, suchphrases are not necessarily referring to the same embodiment. It shouldbe further appreciated that although reference to a “preferred”component or feature may indicate the desirability of a particularcomponent or feature with respect to an embodiment, the disclosure isnot so limiting with respect to other embodiments, which may omit such acomponent or feature. Further, when a particular feature, structure, orcharacteristic is described in connection with an embodiment, it issubmitted that it is within the knowledge of one skilled in the art toimplement such feature, structure, or characteristic in connection withother embodiments whether or not explicitly described. Additionally, itshould be appreciated that items included in a list in the form of “atleast one of A, B, and C” can mean (A); (B); (C); (A and B); (B and C);(A and C); or (A, B, and C). Similarly, items listed in the form of “atleast one of A, B, or C” can mean (A); (B); (C); (A and B); (B and C);(A and C); or (A, B, and C). Further, with respect to the claims, theuse of words and phrases such as “a,” “an,” “at least one,” and/or “atleast one portion” should not be interpreted so as to be limiting toonly one such element unless specifically stated to the contrary, andthe use of phrases such as “at least a portion” and/or “a portion”should be interpreted as encompassing both embodiments including only aportion of such element and embodiments including the entirety of suchelement unless specifically stated to the contrary.

The present disclosure provides a compound having the formula:

or a pharmaceutically acceptable salt thereof.

The chemical name of the compound of Formula (I) is sodium((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate. The molecular formula of the compound of Formula (I) isC₁₇H₂₉N₃Na₂O₁₀P₂. The molecular weight of the compound of Formula (I) is543.11 Da. The compound of Formula (I) is also referred to herein asNu-8 or Compound (I), which such terms are used interchangeably herein.In some embodiments, a compound of the present disclosure includes aribose, two phosphate groups, two butyl groups, and a cytosine.

The compound of Formula (I) is described with reference to the specificcompound illustrated herein. In addition, the compound of Formula (I)may exist in any number of different forms or derivatives, all withinthe scope of the present disclosure. Alternative forms or derivatives,include, for example, pharmaceutically acceptable salts, prodrugs andactive metabolites, tautomers, and solid forms, including withoutlimitation different crystal forms, polymorphic or amorphous solids,including hydrates and solvates thereof, and other forms.

Unless specified to the contrary, specification of the compound ofFormula (I) herein includes pharmaceutically acceptable salts of suchcompound. Thus, the compound of Formula (I) can be in the form ofpharmaceutically acceptable salts or can be formulated aspharmaceutically acceptable salts. Contemplated pharmaceuticallyacceptable salt forms of the present disclosure include, withoutlimitation, mono, bis, tris, tetrakis, and so on. Pharmaceuticallyacceptable salts of the present disclosure are non-toxic in the amountsand concentrations at which such pharmaceutically acceptable salts areadministered. The preparation of such pharmaceutically acceptable saltsof the present disclosure can facilitate the pharmacological use byaltering the physical characteristics of a compound of the presentdisclosure without preventing it from exerting its physiological effect.

As used herein, the term “pharmaceutically acceptable,” with respect tosalts and formulation components such as carriers, excipients, anddiluents, refers to those salts and components which are not deleteriousto a patient and which are compatible with other ingredients, activeingredients, salts or components. Pharmaceutically acceptable includes“veterinarily acceptable,” and thus includes both human and non-humanmammal applications independently.

As used herein, the term “pharmaceutically acceptable salt” refers tosalts commonly used to form alkali metal salts and to form additionsalts of free acids or free bases. Such salts include, for example, thephysiologically acceptable salts listed in Handbook of PharmaceuticalSalts: Properties, Selection and Use, P. H. Stahl and C. G. Wermuth(Eds.), Wiley-VCH, New York, 2002, which are known to the skilledartisan. Salt formation can occur at one or more positions having labileprotons. The pharmaceutically acceptable salts of a compound of thepresent disclosure include both acid addition salts and base additionsalts.

In some embodiments, suitable pharmaceutically acceptable acid additionsalts of the compounds of the present disclosure may be prepared from aninorganic acid or an organic acid. Examples of such inorganic acidsinclude without limitation hydrochloric, hydrobromic, hydroiodic,nitric, carbonic, sulfuric, and phosphoric acid. Appropriate organicacids include without limitation aliphatic, cycloaliphatic, aromatic,arylaliphatic, heterocyclic, carboxylic, and sulfonic classes of organicacids, examples of which are formic, acetic, propionic, succinic,glycolic, gluconic, maleic, embonic (pamoic), methanesulfonic,ethanesulfonic, 2-hydroxyethanesulfonic, pantothenic, benzenesulfonic,toluenesulfonic, sulfanilic, mesylic, cyclohexylaminosulfonic, stearic,algenic, beta-hydroxybutyric, malonic, galactic, and galacturonic acid,to name a few. Pharmaceutically acceptable acidic/anionic salts alsoinclude, the acetate, benzenesulfonate, benzoate, bicarbonate,bitartrate, bromide, calcium edetate, camsylate, carbonate, chloride,citrate, dihydrochloride, edetate, edisylate, estolate, esylate,fumarate, glyceptate, gluconate, glutamate, glycollylarsanilate,hexylresorcinate, hydrobromide, hydrochloride, hydroxynaphthoate,iodide, isethionate, lactate, lactobionate, malate, maleate, malonate,mandelate, mesylate, methylsulfate, mucate, napsylate, nitrate, pamoate,pantothenate, phosphate/diphospate, polygalacturonate, salicylate,stearate, subacetate, succinate, sulfate, hydrogensulfate, tannate,tartrate, teoclate, tosylate, and triethiodide salts, among others.

In some embodiments, suitable pharmaceutically acceptable base additionsalts of the compounds of the present disclosure include withoutlimitation metallic salts made from aluminum, calcium, lithium,magnesium, potassium, sodium and zinc, or organic salts made fromN,N′-dibenzylethylene-diamine, chloroprocaine, choline, diethanolamine,ethylenediamine, N-methylglucamine, lysine, arginine, and procaine. Allof these salts may be prepared by conventional means from a compound ofthe present disclosure by treating a compound of the present disclosurewith the appropriate acid or base. Pharmaceutically acceptablebasic/cationic salts also include diethanolamine, ammonium,ethanolamine, piperazine and triethanolamine salts, to name a few. Insome embodiments, a pharmaceutically acceptable salt of the presentdisclosure comprises a monovalent cation or a divalent cation.

In some embodiments, a pharmaceutically acceptable salt of the presentdisclosure is selected from the group consisting of an ammonium salt, acalcium salt, a sodium salt, a potassium salt, a magnesium salt, and acobalt salt. In some embodiments, the ammonium salt is ammonium ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate. In some embodiments, the calcium salt is calcium ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate. In some embodiments, the sodium salt is sodium ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate. In some embodiments, the potassium salt is potassium((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate. In some embodiments, the magnesium salt is magnesium((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate. In some embodiments, the cobalt salt is cobalt ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate.

Pharmaceutically acceptable salts of the present disclosure can beprepared by standard techniques known in the art to which the presentdisclosure pertains. For example, the free-base form of a compound ofthe present disclosure can be dissolved in a suitable solvent, such asan aqueous or aqueous-alcohol solution containing the appropriate acidand then isolated by evaporating the solution. In another example, asalt can be prepared by reacting the free base and acid in an organicsolvent. If the particular compound is an acid, the desiredpharmaceutically acceptable salt may be prepared by any suitable method,including, for example, treatment of the free acid with an appropriateinorganic or organic base.

In some embodiments, the compound of Formula (I), or a pharmaceuticallyacceptable salt thereof, has certain surprising features and advantagesthat could not have been predicted prior to the present disclosure. Oneadvantage of the compound of Formula (I), or a pharmaceuticallyacceptable salt thereof, in accordance with some embodiments of thepresent disclosure is that such compound and/or salt has a high level ofbiological activity when such compound and/or salt is formulated athigher (less acidic) pH levels. Without being bound by any theory, it isbelieved that the free amino group of the compound of Formula (I), or apharmaceutically acceptable salt thereof, in accordance with someembodiments confers the desired biological activity at higher pH levels.It has been discovered that the compound of Formula (I), or apharmaceutically acceptable salt thereof, in accordance with someembodiments of the present disclosure is unexpectedly more potent at pHlevels above about pH 3. Accordingly, it is believed that the compoundof Formula (I), or a pharmaceutically acceptable salt thereof, inaccordance with some embodiments will be useful for indications in whichprolonged exposure to antimicrobials is advantageous, such as, forexample, microbial infections. Unlike some drugs formulated at belowabout pH 3 resulting in unacceptable contact irritation in topical,inhalation or intravesical administration routes, the compound ofFormula (I), or a pharmaceutically acceptable salt thereof, inaccordance with some embodiments is compatible with topical, inhalationand intravesical administration routes. Additionally, the compound ofFormula (I), or a pharmaceutically acceptable salt thereof, inaccordance with some embodiments is effective against slow growthbacteria since the compound or salt thereof exhibits, in a short periodof time, a high level of biological activity at a higher pH (fast actingantimicrobial mechanism).

In addition to the compound of Formula (I), the present disclosure alsoincludes prodrugs (e.g., pharmaceutically acceptable prodrugs), activemetabolic derivatives (active metabolites), and their pharmaceuticallyacceptable salts.

Prodrugs are compounds or pharmaceutically acceptable salts thereofwhich, when metabolized under physiological conditions or when convertedby solvolysis, yield the desired active compound. Typically, the prodrugis inactive, or less active than the active compound, but may provideone or more advantageous handling, administration, and/or metabolicproperties. Some prodrugs are activated enzymatically to yield theactive compound or a compound may undergo further chemical reaction toyield the active compound. Prodrugs may proceed from prodrug form toactive form in a single step or may have one or more intermediate formswhich such forms have activity or may be inactive.

As described in The Practice of Medicinal Chemistry, Ch. 31-32 (Ed.Wermuth, Academic Press, San Diego, Calif., 2001), prodrugs can beconceptually divided into two non-exclusive categories, includingbioprecursor prodrugs and carrier prodrugs. Generally, bioprecursorprodrugs are compounds that are inactive or have low activity comparedto the corresponding active drug compound that contain one or moreprotective groups and are converted to an active form by metabolism orsolvolysis. Both the active drug form and any released metabolicproducts should have acceptably low toxicity. Typically, the formationof active drug compound involves a metabolic process or reaction that isone of the following types:

Oxidative reactions: Oxidative reactions are exemplified withoutlimitation by reactions such as oxidation of alcohol, carbonyl, and acidfunctionalities, hydroxylation of aliphatic carbons, hydroxylation ofalicyclic carbon atoms, oxidation of aromatic carbon atoms, oxidation ofcarbon-carbon double bonds, oxidation of nitrogen-containing functionalgroups, oxidation of silicon, phosphorus, arsenic, and sulfur, oxidativeN-dealkylation, oxidative O- and S-dealkylation, oxidative deamination,as well as other oxidative reactions.

Reductive reactions: Reductive reactions are exemplified withoutlimitation by reactions such as reduction of carbonyl functionalities,reduction of alcohol functionalities and carbon-carbon double bonds,reduction of nitrogen-containing functional groups, and other reductionreactions.

Reactions without change in the oxidation state: Reactions withoutchange in the state of oxidation are exemplified without limitation byreactions such as hydrolysis of esters and ethers, hydrolytic cleavageof carbon-nitrogen single bonds, hydrolytic cleavage of non-aromaticheterocycles, hydration and dehydration at multiple bonds, new atomiclinkages resulting from dehydration reactions, hydrolyticdehalogenation, removal of hydrogen halide molecule, and other suchreactions.

Carrier prodrugs are drug compounds that contain a transport moiety,e.g., that improves uptake and/or localized delivery to a site(s) ofaction. Desirably for such a carrier prodrug, the linkage between thedrug moiety and the transport moiety is a covalent bond, the prodrug isinactive or less active than the drug compound, and the prodrug and anyrelease transport moiety are acceptably non-toxic. For prodrugs wherethe transport moiety is intended to enhance uptake, typically therelease of the transport moiety should be rapid. In other cases, it isdesirable to utilize a moiety that provides slow release, e.g., certainpolymers or other moieties, such as cyclodextrins. Such carrier prodrugsare often advantageous for orally administered drugs. In some instances,the transport moiety provides targeted delivery of the drug. Forexample, the drug may be conjugated to an antibody or antibody fragment.Carrier prodrugs can, for example, be used to improve one or more of thefollowing properties: increased lipophilicity, increased duration ofpharmacological effects, increased site-specificity, decreased toxicityand adverse reactions, and/or improvement in drug formulation (e.g.,stability, water solubility, suppression of an undesirable organolepticor physiochemical property). For example, lipophilicity can be increasedby esterification of hydroxyl groups with lipophilic carboxylic acids,or of carboxylic acid groups with alcohols, e.g., aliphatic alcohols.Wermuth, supra.

Metabolites, e.g., active metabolites, overlap with prodrugs asdescribed above, e.g., bioprecursor prodrugs. Thus, such metabolites arepharmacologically active compounds or compounds that further metabolizeto pharmacologically active compounds that are derivatives resultingfrom metabolic processes in the body of a subject. Of these, activemetabolites are such pharmacologically active derivative compounds. Forprodrugs, the prodrug compound is generally inactive or of loweractivity than the metabolic product. For active metabolites, the parentcompound may be either an active compound or may be an inactive prodrug.For example, in some compounds, one or more alkoxy groups can bemetabolized to hydroxyl groups while retaining pharmacologic activityand/or carboxyl groups can be esterified, e.g., glucuronidation. In somecases, there can be more than one metabolite, where an intermediatemetabolite(s) is further metabolized to provide an active metabolite.For example, in some cases a derivative compound resulting frommetabolic glucuronidation may be inactive or of low activity and can befurther metabolized to provide an active metabolite.

Metabolites of a compound of the present disclosure may be identifiedusing routine techniques known in the art, and their activitiesdetermined using tests such as those described in Bertolini et al.,1997, J. Med. Chem., 40:2011-2016; Shan et al., 1997, J Pharm Sci86(7):756-757; Bagshawe, 1995, Drug Dev. Res., 34:220-230; Wermuth,supra.

It is understood by those skilled in the art that some compounds mayexhibit tautomerism. In such cases, the formulae provided hereinexpressly depict only one of the possible tautomeric forms. It istherefore to be understood that the compound of Formula (I) intends torepresent any tautomeric form of the depicted compound and is not to belimited merely to the specific tautomeric form depicted by the drawingof the compound.

In the case of agents that are solids, it is understood by those skilledin the art that the compounds and salts may exist in different crystalor polymorphic forms, or may be formulated as co-crystals, or may be inan amorphous form, or may be any combination thereof (e.g. partiallycrystalline, partially amorphous, or mixtures of polymorphs) all ofwhich are intended to be within the scope of the present disclosure andspecified formulae. Whereas salts are formed by acid/base addition(i.e., a free base or free acid of the compound of interest forms anacid/base reaction with a corresponding addition base or addition acid,respectively, resulting in an ionic charge interaction), co-crystals area new chemical species that is formed between neutral compounds,resulting in the compound and an additional molecular species in thesame crystal structure.

In some instances, the compound of Formula (I) is complexed with an acidor a base, including without limitation base addition salts such as, forexample, ammonium, diethylamine, ethanolamine, ethylenediamine,diethanolamine, t-butylamine, piperazine, meglumine; acid additionsalts, such as, for example, acetate, acetylsalicylate, besylate,camsylate, citrate, formate, fumarate, glutarate, hydrochlorate,maleate, mesylate, nitrate, oxalate, phosphate, succinate, sulfate,tartrate, thiocyanate, and tosylate; and amino acids such as, forexample, alanine, arginine, asparagine, aspartic acid, cysteine,glutamine, glutamic acid, glycine, histidine, isoleucine, leucine,lysine, methionine, phenylalanine, proline, serine, threonine,tryptophan, tyrosine or valine.

Additionally, the compound of Formula (I) is intended to cover hydratedor solvated as well as unhydrated or unsolvated forms. Other examples ofsolvates include without limitation the compound of Formula (I) incombination with a suitable solvent, such as isopropanol, ethanol,methanol, DMSO, ethyl acetate, acetic acid or ethanolamine, and thelike.

In some embodiments, a compound of the present disclosure is aprotonated compound. As used herein, the term “protonated compound”refers to a compound of the present disclosure that is protonated byadding protons (or positively charged hydrogen ions) to proton acceptorsites of a compound of the present disclosure. In some embodiments, theproton acceptor sites include the phosphate groups of a compound of thepresent disclosure as well as any additional proton acceptor sites oneither the ribose or the butyl groups of a compound of the presentdisclosure.

As the number of proton acceptor sites that are protonated on a compoundof the present disclosure increases, the pH obtained when a compound ofthe present disclosure is dissolved in water having a pH of 7 decreasesand thus the amount of protonation of a compound of the presentdisclosure can be determined by measuring the pH of solutions of waterafter addition of a compound of the present disclosure. pH indicates thehydrogen ion concentration of a solution.

Solutions with a high concentration of hydrogen ions have a low pH andare therefore acidic, whereas solutions with a low concentration ofhydrogen ions have a high pH and are therefore basic. In someembodiments, the compounds of the present disclosure are protonated sothat when dissolved in water (pH 7) such compounds form an aqueoussolution having a pH of from less than about pH 7 to about pH 1. As usedherein, the term “about,” when used with numerical values is to be readas including the amount(s) specified and variations of 20%, 10%, 5%, 1%,0.5%, and 0.1% of the amount specified. In some embodiments, a compoundof the present disclosure is a protonated compound having a pH whendissolved in water of from less than about pH 6 to about pH 1. In someembodiments, a compound of the present disclosure is a protonatedcompound having a pH when dissolved in water of from about pH 5 to aboutpH 1.

In some embodiments, a compound of the present disclosure is aprotonated compound having a pH when dissolved in water of from about pH4.5 to about pH 1. In some embodiments, a compound of the presentdisclosure is a protonated compound having a pH when dissolved in waterof from about pH 4 to about pH 1. In some embodiments, a compound of thepresent disclosure is a protonated compound having a pH when dissolvedin water of from about pH 3 to about pH 1. In some embodiments, acompound of the present disclosure is a protonated compound having a pHwhen dissolved in water of from about pH 2 to about pH 1. In someembodiments, a compound of the present disclosure is a protonatedcompound having a pH when dissolved in water of about pH 3 to about pH5. In some embodiments, a compound of the present disclosure is aprotonated compound having a pH when dissolved in water of about pH 3 toabout pH 4.

In some embodiments, protonation can be accomplished by incubating acompound of the present disclosure in the presence of a strong acid.Although a compound of the present disclosure can be protonated byadding protons to the reactive sites on the compound, othermodifications of a compound of the present disclosure are possible andare intended to be encompassed by the term protonated compound as usedherein. In some embodiments, protonated forms of the compounds of thepresent disclosure can be generated by subjecting the purified,partially purified or crude compounds to a low pH (e.g., acidic)environment. In some embodiments, purified or crude compounds can beprotonated with acid, including phosphoric acid, nitric acid,hydrochloric acid, and acetic acid.

Other procedures to prepare a protonated compound of the presentdisclosure known to the skilled artisan are equally contemplated to bewithin the scope of the present disclosure. In some embodiments, oncethe compounds of the present disclosure have been protonated, suchcompounds may be separated from any undesired components such as, forexample, excess acid. The skilled artisan would know of many ways toseparate the compounds from undesired components, including but notlimited to using an H+-cation exchanger (e.g., H+-SCX). In someembodiments, the compounds of the present disclosure may be subjected tochromatography following protonation. In some embodiments, a compound ofthe present disclosure is run over a poly(styrene-divinyl benzene) basedresin (e.g., Hamilton's PRP-1 or 3 and Polymer Lab's PLRP) followingprotonation.

In some embodiments, the protonated compounds of the present disclosurecan be used directly. In some embodiments, the protonated compounds ofthe present disclosure can be processed further to remove any excessacid or salt, e.g., via precipitation, reverse phase chromatography,diafiltration or gel filtration. In some embodiments, the protonatedcompounds of the present disclosure can be concentrated bylyophilization, solvent evaporation, and the like. In some embodiments,when suspended in water or saline, the compounds of the presentdisclosure generally exhibit a pH of from about pH 3 to about pH 5depending upon the level of protonation/acidification, which isdetermined by how much acid is used in the acidification process. Insome embodiments, compounds of the present disclosure can be protonatedby passage over a cation exchange column charged with hydrogen ions.

In some embodiments, utilization of two butyl groups in a compound ofthe present disclosure prevents or limits substantial nucleasedegradation, including without limitation exonuclease degradation, of acompound of the present disclosure. In some embodiments, the butylgroups are positioned to protect the ribose of a compound of the presentdisclosure. Percent acid degradation may be determined using analyticalHPLC to assess the loss of functional molecules or by other suitablemethods. Acid degradation is generally measured as a function of time.In some embodiments, the compounds of the present disclosure are alsonuclease resistant, which allows such compounds to maintain activity(e.g., pH stability) in an in vivo setting. Percent degradation of thecompounds of the present disclosure in a setting containing a nucleasemay be determined by methods known to those skilled in the art, such as,for example, mass spectroscopy. Nuclease degradation is generallymeasured as a function of time. In some embodiments, a referencecompound is employed in determining the extent or rate of acid ornuclease degradation. In some embodiments, the compounds of the presentdisclosure are 10%, 20%, 30%, 40%, 50%, 70%, 90%, 100%, 150%, 200%,300%, 500% or 750% more stable than a reference compound.

A compound of the present disclosure in accordance with some embodimentsis useful as an antimicrobial having activity against any microbe. Asused herein, the terms “microbe,” “microbial,” and like terms refers tobacteria, fungi, protozoa, viruses, yeast, and the like. As used herein,the term “antimicrobial” refers to a compound of the present disclosurehaving the ability to kill or inhibit the growth of a microbe, or toattenuate the severity of a microbial infection. A non-limiting list ofthe bacteria that a compound of the present disclosure is effectiveagainst include without limitation gram positive bacteria, gram negativebacteria, slow growing bacteria and acid fast bacteria, and any speciesincluded in the following genera: Aerococcus, Listeria, Streptomyces,Chlamydia, Lactobacillus, Eubacterium, Burkholderia, Stentrophomonas,Achromobacter, Arachnid, Mycobacterium, Peptostreptococcus,Staphylococcus, Corynebacterium, Erysipelothrix, Dermatophilus,Rhodococcus, Pseudomonas, Streptococcus, Bacillus, Peptococcus,Pneumococcus, Micrococcus, Neisseria, Klebsiella, Kurthia, Nocardia,Serratia, Rothia, Escherichia, Propionibacterium, Actinomyces,Helicobacter, Enterococcus, Shigella, Vibrio, Clostridium, Salmonella,Yersinia, and Haemophilus.

A non-limiting list of the fungi that a compound of the presentdisclosure is effective against include without limitation Trichophyton,Epidermophyton, Microsporum, Candida albicans and other Candida species,Pityrosporum orbiculare, Trichophyton mentagrophytes, Trichophytonrubrum, Epidermophyton floccosurn, and Trichophyton tonsurans. Anon-limiting list of the viruses that a compound of the presentdisclosure is effective against include without limitation humanimmunodeficiency virus (HIV), herpes simplex virus (HSV),cytomegalovirus (CMV), Hepatitis B virus (HBV), Hepatitis C virus (HCV),and influenza virus.

In some embodiments, a compound of the present disclosure is useful inboth therapeutic and non-therapeutic medical applications. In someembodiments including non-therapeutic medical applications, theantimicrobial effect of a compound of the present disclosure allows useof a compound of the present disclosure for sterilization (e.g.,sterilization of a patient's skin or of a surface or an object, such as,for example, a surgical instrument), or sanitization (e.g., thecleansing of a surface, instrument, as to render the surface free ofundesirable concentrations of disease causing microorganisms). In someembodiments, the compounds of the present disclosure are effective incombating microbial contamination of laboratory cultures, consumables(e.g., food or beverage preparations), medical devices, hospitalapparatus, or industrial processes. Therapeutic applications of acompound of the present disclosure are described herein.

The present disclosure also provides pharmaceutical compositions. Asused herein, the term “pharmaceutical composition” refers to apharmaceutical preparation that contains a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, and issuitable for administration to a patient for therapeutic purposes. Asused herein, the term “patient” refers to a living organism that istreated with a compound of the present disclosure, including withoutlimitation any mammal such as, for example, humans, other primates(e.g., monkeys, chimpanzees, etc.), companion animals (e.g., dogs, cats,horses, etc.), farm animals (e.g., goats, sheep, pigs, cattle, etc.),laboratory animals (e.g., mice, rats, etc.), and wild and zoo animals(e.g., wolves, bears, deer, etc.).

In some embodiments, the pharmaceutical composition may include at leastone pharmaceutically acceptable component to provide an improvedformulation of a compound of the present disclosure, including withoutlimitation one or more pharmaceutically acceptable carriers, excipientsor diluents. The carrier, excipient or diluent may take a wide varietyof forms depending on the form of preparation desired foradministration.

As used herein, the term “carrier” includes without limitation calciumcarbonate, calcium phosphate, various sugars, such as lactose, glucose,or sucrose, types of starch, cellulose derivatives, gelatin, lipids,liposomes, nanoparticles, physiologically acceptable liquids as solventsor for suspensions, including, for example, sterile solutions of waterfor injection (WFI), saline solution, dextrose solution, Hank'ssolution, Ringer's solution, vegetable oils, mineral oils, animal oils,polyethylene glycols, liquid paraffin, and the like.

As used herein, the term “excipient” generally includes withoutlimitation fillers, binders, disintegrants, glidants, lubricants,complexing agents, solubilizers, stabilizer, preservatives, andsurfactants, which may be chosen to facilitate administration of thecompound by a particular route. Suitable excipients may also include,for example, colloidal silicon dioxide, silica gel, talc, magnesiumsilicate, calcium silicate, sodium aluminosilicate, magnesiumtrisilicate, powdered cellulose, macrocrystalline cellulose,carboxymethyl cellulose, cross-linked sodium carboxymethylcellulose,sodium benzoate, calcium carbonate, magnesium carbonate, stearic acid,aluminum stearate, calcium stearate, magnesium stearate, zinc stearate,sodium stearyl fumarate, syloid, stearowet C, magnesium oxide, starch,sodium starch glycolate, glyceryl monostearate, glyceryl dibehenate,glyceryl palmitostearate, hydrogenated vegetable oil, hydrogenatedcotton seed oil, castor seed oil, mineral oil, polyethylene glycol(e.g., PEG 4000-8000), polyoxyethylene glycol, poloxamers, povidone,crospovidone, croscarmellose sodium, alginic acid, casein, methacrylicacid divinylbenzene copolymer, sodium docusate, cyclodextrins (e.g.,2-hydroxypropyl-delta-cyclodextrin), polysorbates (e.g., polysorbate80), cetrimide, TPGS (d-alpha-tocopheryl polyethylene glycol 1000succinate), magnesium lauryl sulfate, sodium lauryl sulfate,polyethylene glycol ethers, di-fatty acid ester of polyethylene glycols,or a polyoxyalkylene sorbitan fatty acid ester (e.g., polyoxyethylenesorbitan ester Tween®), polyoxyethylene sorbitan fatty acid esters,sorbitan fatty acid ester, e.g., a sorbitan fatty acid ester from afatty acid such as oleic, stearic or palmitic acid, mannitol, xylitol,sorbitol, maltose, lactose, lactose monohydrate or lactose spray dried,sucrose, fructose, calcium phosphate, dibasic calcium phosphate,tribasic calcium phosphate, calcium sulfate, dextrates, dextran,dextrin, dextrose, cellulose acetate, maltodextrin, simethicone,polydextrosem, chitosan, gelatin, HPMC (hydroxypropyl methylcelluloses), HPC (hydroxypropyl cellulose), hydroxyethyl cellulose, andthe like.

As the skilled artisan understands, any diluent known in the art may beutilized in accordance with the present disclosure. In some embodimentsof the present disclosure, the diluent is water soluble. In someembodiments of the present disclosure, the diluent is water insoluble.As used herein, the term “diluent” includes without limitation water,saline, phosphate buffered saline (PBS), dextrose, glycerol, ethanol,buffered sodium or ammonium acetate solution, or the like, andcombinations thereof.

In some embodiments, the pharmaceutical compositions of the presentdisclosure include at least one additional active ingredient. As usedherein, the term “active ingredient” refers to a therapeutically activecompound, as well as any prodrugs thereof and pharmaceuticallyacceptable salts, hydrates, and solvates of the compound and theprodrugs. Additional active ingredients may be combined with a compoundof the present disclosure and may be either administered separately orin the same pharmaceutical composition. The amount of additional activeingredients to be given may be determined by one skilled in the artbased upon therapy with a compound of the present disclosure.

In some embodiments, the pharmaceutical composition is a humanpharmaceutical composition. As used herein, the term “humanpharmaceutical composition” refers to a pharmaceutical compositionintended for administration to a human.

The pharmaceutical compositions of the present disclosure are suitablefor administration to a patient by any suitable means, including withoutlimitation those means used to administer conventional antimicrobials.The pharmaceutical compositions of the present disclosure may beadministered using any applicable route that would be considered by oneof ordinary skill, including without limitation oral, intravenous (“IV”)injection or infusion, intravesical, subcutaneous (“SC”), intramuscular(“IM”), intraperitoneal, intradermal, intraocular, inhalation (andintrapulmonary), intranasal, transdermal, epicutaneously, subdermal,topical, mucosal, nasal, ophthalmic, impression into skin, intravaginal,intrauterine, intracervical, and rectal. Such dosage forms should allowa compound of the present disclosure to reach target cells. Otherfactors are well known in the art and include considerations such astoxicity and dosage forms that retard a compound or composition fromexerting its effects. Techniques and formulations generally may be foundin Remington: The Science and Practice of Pharmacy, 21st edition,

Lippincott, Williams and Wilkins, Philadelphia, Pa., 2005.

In some embodiments, the pharmaceutical compositions of the presentdisclosure are adapted for topical administration. As used herein, theterm “topical administration” refers to administration of a compound ofthe present disclosure to the skin surface of a patient so that acompound of the present disclosure passes through the skin layer.Transdermal administration and transmucosal administration are alsoencompassed within the term topical administration. As used herein, theterm “transdermal” refers to passage of a compound of the presentdisclosure across at least one skin layer of a patient. As used herein,“transmucosal” refers to passage of a compound of the present disclosureacross a mucous membrane of a patient. Unless otherwise stated orimplied, the terms “topical administration,” “transdermaladministration,” and “transmucal administration” are usedinterchangeably herein.

A variety of topical delivery systems for delivering bioactive compoundsto microbes in an patient are well known in the art. Such systemsinclude without limitation lotions, creams, gels, oils, ointments,solutions, suspensions, emulsions, and the like by choice of appropriatecarriers in the art. In some embodiments, the pharmaceutical compositionis administered in the form of a gel including a polyhydric alcohol.

Suitable carriers include without limitation vegetable or mineral oils,white petrolatum (e.g., white soft paraffin), branched chain fats oroils, animal fats and high molecular weight alcohol (e.g., greater thanC12). In some embodiments, carriers are selected such that a compound ofthe present disclosure is soluble. In some embodiments, emulsifiers,stabilizers, humectants, and antioxidants may also be included as wellas agents imparting color or fragrance, if desired. In some embodiments,an organic solvent or co-solvent such as ethanol or propanol may beemployed in the pharmaceutical compositions of the present disclosure.In some embodiments, evaporation of the solvent leaves a residue on thetreated surface to inhibit reinfection. In some embodiments, penetrantsappropriate to the barrier to be permeated are used. Such penetrants aregenerally known in the art and include without limitation bile salts andfusidic acid derivatives. In some embodiments, detergents may be used tofacilitate permeation. In some embodiments, creams for topicaladministration are formulated from a mixture of mineral oil,self-emulsifying beeswax, and water in which mixture a compound of thepresent disclosure, dissolved in a small amount of solvent (e.g., anoil), is admixed. The specific topical delivery system used depends onthe location of the microbes.

In some embodiments, other materials may also be added to the topicalpharmaceutical compositions of the present disclosure have additionalmoisturizing effects and to improve the consistency of thepharmaceutical composition. Examples of such compounds include withoutlimitation cetyl esters wax, stearyl alcohol, cetyl alcohol, glycerin,methyl paraben, propyl paraben, quaternium-15, humectants, volatilemethylsiloxane fluids, and polydiorganosiloxane-polyoxyalkylene. See,e.g., U.S. Pat. Nos. 5,153,230 and 4,421,769. If it is desirable for thepharmaceutical composition to have additional cleaning effects in someembodiments, chemicals such as sodium lauryl sulfate or a metal salt ofa carboxylic acid may be added.

In some embodiments, a wide variety of nonvolatile emollients are usefulin the pharmaceutical compositions of the present disclosure.Non-limiting examples of such nonvolatile emollients are listed inMcCutcheon's, Vol. 2 Functional Materials, North American Edition,(1992), pp. 137-168, and CTFA Cosmetic Ingredient Handbook, SecondEdition (1992) which lists Skin-Conditioning Agents at pp. 572-575 andSkin Protectants at p. 580. In some embodiments, the nonvolatileemollients include silicones, hydrocarbons, esters, and mixturesthereof. In some embodiments, the esters include esters ofmonofunctional and difunctional fatty acids that have been esterifiedwith alcohols and polyols (i.e., alcohols having two or more hydroxylgroups). In some embodiments, long chain esters of long chain fattyacids are utilized in the pharmaceutical compositions of the presentdisclosure (i.e., C10-40 fatty acids esterified with C10-40 fattyalcohols). Non-limiting examples of esters useful in the pharmaceuticalcompositions of the present disclosure include without limitation thoseselected from the group consisting of diisopropyl adipate, isopropylmyristate, isopropyl palmitate, myristyl propionate, ethylene glycoldistearate, 2-ethylhexyl palmitate, isodecyl neopentanoate, C12-15alcohol benzoate, di-2-ethylhexyl maleate, ceryl palmitate, myristylmyristate, stearyl stearate, cetyl stearate, behenyl behenrate, andmixtures thereof.

Examples of silicone emollients useful in the pharmaceuticalcompositions of the present disclosure include without limitationpolyalkylsiloxanes, cyclic polyalkylsiloxanes, andpolyalkylarylsiloxanes. Suitable commercially availablepolyalkylsiloxanes include the polydimethylsiloxanes, which are alsoknown as dimethicones, non-limiting examples of which include theVicasil™ series sold by General Electric Company and the Dow Corning™200 series sold by Dow Corning Corporation. Commercially availablepolyalkylsiloxanes include cyclomethicones (Dow Corning™ 244 fluid), DowCorning™ 344 fluid, Dow Corning™ 245 fluid and Dow Corning™ 345), amongothers. A suitable commercially available trimethylsiloxysilicate issold as a mixture with dimethicone as Dow Corning™ 593 fluid. Alsouseful in the pharmaceutical compositions of the present disclosure aredimethiconols, which are hydroxyl terminated dimethyl silicones.Suitable commercially available dimethiconols are typically sold asmixtures with dimethicone or cyclomethicone (e.g., Dow Corning™ 1401,1402, and 1403 fluids). Suitable commercially availablepolyalkylarylsiloxanes include SF1075 methylphenyl fluid (sold byGeneral Electric Company) and 556 Cosmetic Grade phenyl trimethiconefluid (sold by Dow Coring Corporation).

Hydrocarbons suitable for use in the pharmaceutical compositions of thepresent disclosure include without limitation straight and branchedchain hydrocarbons having from about 10 to about 30 carbon atoms. Insome embodiments, the straight and branched chain hydrocarbons have fromabout 12 to about 24 carbon atoms. In some embodiments, the straight andbranched chain hydrocarbons have from about 16 to about 22 carbon atoms.Non-limiting examples of such hydrocarbon materials include dodecane,squalane, cholesterol, 5 hydrogenated polyisobutylene, docosane (i.e., aC22 hydrocarbon), hexadecane, and isohexadecane (a commerciallyavailable hydrocarbon sold as Permethyl™ 101A by Presperse, SouthPlainsfield, N.J.), among others.

In some embodiments, the topical pharmaceutical compositions of thepresent disclosure include propylene glycol. In some embodiments,propylene glycol acts as a surfactant and assists in penetration,contact, and absorption of a compound of the present disclosure. In someembodiments, propylene glycol serves as a preservative. In someembodiments, the pharmaceutical compositions of the present disclosureinclude a non-ionic surfactant, such as, for example, polysorbate. Sucha surfactant provides better surface contact of the pharmaceuticalcompositions of the present disclosure with mucosa (such as vaginalmucosa) by further reducing surface tension.

The topical pharmaceutical compositions of the present disclosureoptionally may also be formulated with a lipophilic phase, such as, forexample, emulsions and liposome dispersions. In some embodiments,liposomal formulations may extend circulation time of a compound of thepresent disclosure, increase permeability of a compound of the presentdisclosure, and improve overall efficacy of a compound of the presentdisclosure as an antimicrobial. In some embodiments, a compound of thepresent disclosure may be combined with a lipid, cationic lipid oranionic lipid. In some embodiments, the resulting emulsion or liposomalsuspension in conjunction with the pH stabilizing qualities of acompound of the present disclosure can effectively increase the in vivohalf-life of the activity of a pharmaceutical composition of the presentdisclosure. Examples of suitable anionic lipids for use with thepharmaceutical compositions of the present disclosure include, but arenot limited to, cardiolipin, dimyristoyl, dipalmitoyl, dioleoylphosphatidyl choline, phosphatidyl glycerol, palmitoyloleoylphosphatidyl choline, phosphatidyl glycerol, phosphatidic acid,lysophosphatidic acid, phosphatidyl serine, phosphatidyl inositol, andanionic forms of cholesterol.

In some embodiments, a compound of the present disclosure isincorporated into liposomes. In some embodiments, neutral lipids,cholesterol, and/or polyethylene glycol (PEG) are utilized in suchliposomes. In some embodiments, the liposomal composition is composed ofpartially hydrogenated soy phosphatidylcholine (PHSC), cholesterol,methoxy-terminated PEG (mPEG), and/or distearoyl phosphatidylethanolamine (DSPE). The liposomes can be prepared according to anysuitable method known in the art.

In some embodiments, topical administration is through nasal sprays orsuppositories (rectal or vaginal). Suppositories are prepared by mixinga compound of the present disclosure with a lipid vehicle such asTheobroma oil, cacao butter, glycerin, gelatin, polyoxyethylene glycols,and the like. In some embodiments, topical administration comprises atransdermal patch or dressing such as a bandage impregnated with acompound of the present disclosure and optionally one or more carriers,excipients or diluents known in the art. In some embodiments, suchdressings include without limitation semipermeable films, foams,hydrocolloids, and calcium alginate swabs. In some embodiments, thedosage administration will be continuous rather than intermittentthroughout the dosage regimen.

In some embodiments, the pharmaceutical compositions of the presentdisclosure are adapted for oral administration. As used herein, the term“oral administration” refers to administration of a compound of thepresent disclosure to the mouth of a patient for ingestion into thegastrointestinal tract. In some embodiments, the pharmaceuticalcompositions of the present disclosure can be formulated intoconventional oral dosage forms including without limitation capsules,tablets, powders, and liquid preparations such as suspensions,solutions, elixirs, syrups, concentrated drops, and the like. In someembodiments, a compound of the present disclosure may be combined withsolid excipients, optionally grinding a resulting mixture, andoptionally processing the mixture of granules, after adding suitableauxiliaries, if desired, to obtain, for example, tablets, coatedtablets, hard capsules, soft capsules, solutions (e.g., aqueous,alcoholic or oily solutions), and the like. In some embodiments,excipients suitable for use in the oral pharmaceutical compositions ofthe present disclosure include without limitation fillers such assugars, including lactose, glucose, sucrose, mannitol, or sorbitol;cellulose preparations, for example, corn starch, wheat starch, ricestarch, potato starch, gelatin, gum tragacanth, methyl cellulose,hydroxypropylmethyl-cellulose, sodium carboxymethylcellulose (CMC),and/or polyvinylpyrrolidone (PVP or povidone); and oily excipients,including vegetable and animal oils, such as sunflower oil, olive oil,or cod liver oil. In some embodiments, the oral pharmaceuticalcompositions of the present disclosure may also contain disintegratingagents, such as, for example, cross-linked polyvinylpyrrolidone, agar,or alginic acid, or a salt thereof such as sodium alginate; a lubricant,such as talc or magnesium stearate; a plasticizer, such as glycerol orsorbitol; a sweetening agent such as sucrose, fructose, lactose, oraspartame; a natural or artificial flavoring agent, such as, forexample, peppermint, oil of wintergreen, or cherry flavoring; ordye-stuffs or pigments, which may be used for identification orcharacterization of different doses or combinations. In someembodiments, the oral pharmaceutical compositions of the presentdisclosure may also contain dragée cores with suitable coatings. In someembodiments, concentrated sugar solutions may be used, which mayoptionally contain, for example, gum arabic, talc,poly-vinylpyrrolidone, carbopol gel, polyethylene glycol, titaniumdioxide, lacquer solutions, and suitable organic solvents or solventmixtures.

In some embodiments, the pharmaceutical compositions of the presentdisclosure that can be used orally include without limitation push-fitcapsules made of gelatin (“gelcaps”), as well as soft, sealed capsulesmade of gelatin, and a plasticizer, such as glycerol or sorbitol. Insome embodiments, the push-fit capsules can contain a compound of thepresent disclosure in admixture with filler such as lactose, binderssuch as starches, and/or lubricants such as talc or magnesium stearateand, optionally, stabilizers. In some embodiments including softcapsules, the active compound may be dissolved or suspended in suitableliquids, such as fatty oils, liquid paraffin, liquid polyethyleneglycols, and the like.

In some embodiments, the pharmaceutical compositions of the presentdisclosure are adapted for inhalation administration. As used herein,the term “inhalation administration” refers to delivery of a compound ofthe present disclosure by passage through a patient's nose or mouthduring inhalation and passage of the compound through the walls of thelungs of the patient. In some embodiments, the pharmaceuticalcompositions of the present disclosure suitable for inhalationadministration may be formulated as dry powder or a suitable solution,suspension or aerosol. In some embodiments, powders and solutions may beformulated with suitable additives known in the art. In someembodiments, powders may include a suitable powder base such as lactoseor starch. In some embodiments, solutions may comprise propylene glycol,sterile water, ethanol, sodium chloride, and other additives, such as,for example, acid, alkali, and buffer salts. In some embodiments, suchsolutions or suspensions may be administered by inhaling via a spray,pump, atomizer, nebulizer, and the like. In some embodiments, thepharmaceutical compositions of the present disclosure suitable forinhalation administration may also be used in combination with otherinhaled therapies, including without limitation corticosteroids such as,for example, fluticasone proprionate, beclomethasone dipropionate,triamcinolone acetonide, budesonide, and mometasone furoate; betaagonists such as, for example, albuterol, salmeterol, and formoterol;anticholinergic agents such as, for example, ipratroprium bromide ortiotropium;

vasodilators such as, for example, treprostinal and iloprost; enzymessuch as, for example, DNAase; therapeutic proteins; immunoglobulinantibodies; an oligonucleotide, such as, for example, single or doublestranded DNA or RNA, siRNA; antibiotics such as, for example,tobramycin; muscarinic receptor antagonists; leukotriene antagonists;cytokine antagonists; protease inhibitors; cromolyn sodium; nedocrilsodium; and sodium cromoglycate.

In some embodiments, the pharmaceutical compositions of the presentdisclosure are adapted for intravesical administration. As used herein,the term “intravesical administration” refers to delivery of a compoundof the present disclosure directly into the bladder of a patient. Insome embodiments, the pharmaceutical composition is administered via acatheter. In some embodiments, the catheter is a urethral catheter.

In some embodiments, the pharmaceutical compositions of the presentdisclosure are adapted for parenteral administration. As used herein,the term “parenteral administration” refers to a compound of the presentdisclosure being injected or infused into a patient and includes withoutlimitation intravenous, intramuscular, intraarterial, intrathecal,intraventricular, intracapsular, intraorbital, intracardiac,intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular,intraarticular, sub capsular, subarachnoid, intraspinal, intracerebrospinal, and intrasternal injection and infusion. In some embodiments,the pharmaceutical compositions of the present disclosure suitable forparenteral administration may be formulated in sterile liquid solutions,including without limitation physiologically compatible buffers orsolutions, such as, for example, saline solution, Hank's solution orRinger's solution. In some embodiments, the pharmaceutical compositionsof the present disclosure suitable for parenteral administration may beprepared as dispersions in non-aqueous solutions, such as, for example,glycerol, propylene glycol, ethanol, liquid polyethylene glycols,triacetin, vegetable oils, and the like. In some embodiments, solutionsmay also contain a preservative, such as, for example, methylparaben,propylparaben, chlorobutanol, phenol, sorbic acid, thimerosal, and thelike. In addition, pharmaceutical compositions of the present disclosuresuitable for parenteral administration may be formulated in solid form,including, for example, lyophilized forms, and redissolved or suspendedprior to use. In some embodiments, the pharmaceutical composition isadministered via a needle.

In some embodiments, the present disclosure provides methods andcompositions of pretreating a catheter with a compound of the presentdisclosure, for example, to prevent an infection after the catheter isinserted into a patient. In some embodiments, a method of the presentdisclosure includes coating a catheter with a compound of the presentdisclosure prior to inserting the catheter into a patient. In someembodiments, the present disclosure provides a composition comprising acatheter coated with a compound of the present disclosure. In someembodiments, such methods and compositions may be used as a prophylactictreatment of an infection in a patient.

The present disclosure also provides methods of treatment. As usedherein, the terms “treating,” “treatment,” “therapy,” and like termsrefer to administration of a compound or pharmaceutical composition ofthe present disclosure in an amount effective to prevent, alleviate orameliorate one or more symptoms of a disease or condition (i.e.,indication) and/or to prolong the survival of the patient being treated.In some embodiments, “treating,” “treatment,” “therapy,” and like termsalso include without limitation reducing or eliminating infection in apatient.

In carrying out the methods of the present disclosure, an effectiveamount of a compound of the present disclosure is administered to apatient in need thereof. As used herein, the term “effective amount,” inthe context of administration, refers to the amount of a compound orpharmaceutical composition of the present disclosure that whenadministered to a patient is sufficient to prevent, alleviate orameliorate one or more symptoms of a disease or condition (i.e.,indication) and/or to prolong the survival of the patient being treated.Such an amount should result in no or few adverse events in the treatedpatient. Similarly, such an amount should result in no or few toxiceffects in the treated patient. As those familiar with the art willunderstand, the amount of a compound or pharmaceutical composition ofthe present disclosure will vary depending upon a number of factors,including without limitation the activity of a compound of the presentdisclosure (in vitro, e.g. a compound of the present disclosure vs.target, or in vivo activity in animal efficacy models), pharmacokineticresults in animal models (e.g., biological half-life orbioavailability), the type of patient being treated, the patient's age,size, weight, and general physical condition, the disorder associatedwith the patient, and the dosing regimen being employed in thetreatment.

In some embodiments of the present disclosure, an effective amount of acompound of the present disclosure to be delivered to a patient in needthereof can be quantified by determining micrograms of a compound of thepresent disclosure per kilogram of patient body weight. In someembodiments, the amount of a compound of the present disclosureadministered to a patient is from about 0.1 to about 1000 milligram (mg)of a compound of the present disclosure per kilogram (kg) of patientbody weight. In some embodiments, the amount of a compound of thepresent disclosure administered to a patient is from about 0.1 to about500 mg of a compound of the present disclosure per kg of patient bodyweight. In some embodiments, the amount of a compound of the presentdisclosure administered to a patient is from about 0.1 to about 300 mgof a compound of the present disclosure per kg of patient body weight.In some embodiments, the amount of a compound of the present disclosureadministered to a patient is from about 0.1 to about 200 mg of acompound of the present disclosure per kg of patient body weight. Insome embodiments, the amount of a compound of the present disclosureadministered to a patient is from about 0.1 to about 100 mg of acompound of the present disclosure per kg of patient body weight. Asthose of ordinary skill in the art understand multiple doses may beused.

In some embodiments of the present disclosure, a compound of the presentdisclosure is administered as a multiple dose regimen. As used herein,the term “multiple dose regimen” refers to a treatment time period ofmore than one day. In some embodiments of the present disclosure, themultiple dose regimen is a time period of up to about 2 days. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 3 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 4days. In some embodiments of the present disclosure, the multiple doseregimen is a time period of up to about 5 days. In some embodiments ofthe present disclosure, the multiple dose regimen is a time period of upto about 6 days. In some embodiments of the present disclosure, themultiple dose regimen is a time period of up to about 7 days. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 14 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to aboutone month. In some embodiments of the present disclosure, the multipledose regimen is a time period of up to about two months. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about three months. In some embodiments of thepresent disclosure, the multiple dose regimen is a time period of up toabout four months. In some embodiments of the present disclosure, themultiple dose regimen is a time period of up to about five months. Insome embodiments of the present disclosure, the multiple dose regimen isa time period of up to about six months. Other time periods may be usedherein.

In some embodiments of the present disclosure, a compound of the presentdisclosure is administered as part of a chronic treatment regimen. Asused herein, the term “chronic treatment regimen” refers to treatmentwith a compound of the present disclosure over an extended period oftime during a patient's lifetime. In some embodiments, chronic treatmentis lifelong treatment.

In some embodiments of the present disclosure, a compound of the presentdisclosure is administered as a single dose. In some embodiments of thepresent disclosure, a compound of the present disclosure is administeredas a single unit dose. As used herein, the term “unit dose” is apredetermined amount of a compound of the present disclosure. The amountof a compound of the present disclosure is generally equal to the dosageof a compound of the present disclosure that would be administered to apatient or a convenient fraction of such a dosage such as, for example,one-half or one-third of such a dosage. According to the methods of thepresent disclosure, the terms “single dose” and “single unit dose”include embodiments wherein a compound of the present disclosure can beadministered as a single application and administered as multipleapplications.

In some embodiment, a compound of the present disclosure may also beused in combination with one or more additional active ingredients fortreating the same disease or condition. In some embodiments, suchcombination use includes administration of a compound of the presentdisclosure and one or more additional active ingredient at differenttimes, or co-administration of a compound of the present disclosure andone or more additional active ingredients. In some embodiments, dosagemay be modified for a compound of the present disclosure or one or moreadditional active ingredients used in combination, e.g., reduction inthe amount dosed relative to a compound of the present disclosure or oneor more additional active ingredients used alone, by methods well knownto those of ordinary skill in the art. In some embodiments,co-administration includes simultaneous administration of a compound ofthe present disclosure and an additional active ingredient in the samedosage form, simultaneous administration of a compound of the presentdisclosure and an additional active ingredient in separate dosage forms,and separate administration of a compound of the present disclosure andan additional active ingredient.

It is understood that use in combination includes use with one or moreadditional active ingredients or other medical procedure in which theone or more additional active ingredients or other medical procedure maybe administered at different times (e.g., within a short time, such aswithin hours (e.g., 1, 2, 3, 4-24 hours, etc.), or within a longer time(e.g. 1-2 days, 2-4 days, 4-7 days, 1-4 weeks, etc.)) than a compound orpharmaceutical composition of the present disclosure, or at the sametime as a compound or pharmaceutical composition of the presentdisclosure. Use in combination also includes use with one or moreadditional active ingredients or other medical procedure that isadministered once or infrequently, such as surgery, along with acompound or pharmaceutical composition of the present disclosureadministered within a short time or longer time before or after theadministration of the one or more additional active ingredients orcompletion of the other medical procedure.

In some embodiments, the present disclosure provides for delivery of acompound or pharmaceutical composition of the present disclosure and oneor more additional active ingredients delivered by a different route ofadministration or by the same route of administration. In someembodiments, the use in combination for any route of administrationincludes delivery of a compound or pharmaceutical composition of thepresent disclosure and one or more additional active ingredientsdelivered by the same route of administration together in anypharmaceutical composition, including pharmaceutical compositions inwhich the two compounds are chemically linked in such a way that suchcompounds maintain their therapeutic activity when administered. In someembodiments, the one or more additional active ingredients may beco-administered with a compound or pharmaceutical composition of thepresent disclosure. In some embodiments, use in combination byco-administration includes administration of co-formulations orformulations of chemically joined compounds, or administration of two ormore compounds in separate formulations within a short time of eachother (e.g., within an hour, 2 hours, 3 hours, up to 24 hours, etc.),administered by the same or different routes. In some embodiments,co-administration of separate formulations includes co-administration bydelivery via one device, for example, the same inhalant device, the samesyringe, etc., or administration from separate devices within a shorttime of each other. In some embodiments, co-formulations of a compoundor pharmaceutical composition of the present disclosure and one or moreadditional active ingredients delivered by the same route includespreparation of the materials together such that they can be administeredby one device, including the separate compounds combined in oneformulation, or compounds that are modified such that the compounds arechemically joined, yet still maintain their biological activity. In someembodiments, such chemically joined compounds may have a linkage that issubstantially maintained in vivo, or the linkage may break down in vivo,separating the two active components.

The present disclosure also provides a method of treating an infectionin a patient in need thereof. In some embodiments, the method comprisesadministering an effective amount of a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, to thepatient. As used herein, the term “infection” refers to any microbeinfection of a patient's body. Infection includes the invasion of apatient's body by a microbe and subsequent multiplication in thepatient's body.

The present disclosure also provides a method of treating an infectionof at least one of a wound or an ulcer in a patient in need thereof. Insome embodiments, the method comprises administering an effective amountof a compound of the present disclosure, or a pharmaceuticallyacceptable salt thereof, to the patient. As used herein, the term“wound” refers to an injury to the body of a patient that may involvelaceration or breaking of a membrane (e.g., skin) and/or damage tounderlying tissues. As used herein, the term “ulcer” refers to a breakin skin or mucous membrane with loss of surface tissue, disintegration,and necrosis of epithelial tissue. In some embodiments, an ulcer mayinvolve pus.

The present disclosure also provides a method of treating an infectionof a lower extremity ulcer in a patient in need thereof. In someembodiments, the method comprises administering an effective amount of acompound of the present disclosure, or a pharmaceutically acceptablesalt thereof, to the patient. As used herein, the term “lower extremity”refers to a lower limb of a patient's body, including without limitationthe hip, thigh, leg, ankle, and foot.

In some embodiments, the present disclosure provides a method oftreating an infection of a diabetic foot ulcer in a patient in needthereof. In some embodiments, the method comprises administering aneffective amount of a compound of the present disclosure, or apharmaceutically acceptable salt thereof, to the patient. In someembodiments, the patient is suffering from Type I diabetes or Type IIdiabetes. As used herein, the term “diabetic foot ulcer” refers to anulcer located anywhere on the foot of a patient. In some embodiments,the ulcer is located on the heel, mid-foot, and/or forefoot of thepatient's foot. As used herein, the term “treating,” in the context of adiabetic foot ulcer, also includes without limitation reducing oreliminating infection in a patient, which, in some embodiments, resultsin limiting the progression in size, area, and/or depth of the footulcer; reducing the size, area, and/or depth of the foot ulcer;increasing the rate of healing and/or reducing time to healing; healingof the foot ulcer (about 100% epithelialization with no drainage);and/or decreased incidence of amputation or slowing in time toamputation.

In some embodiments, the patient is a human. In some embodiments, theadministration is topical administration. In some embodiments, theadministration is carried out using the compound, or a pharmaceuticallyacceptable salt thereof, in a lotion, paste, gel, cream, ointment, oilor other viscous composition. In some embodiments, the patient isadministered at least one additional active ingredient. In someembodiments, the administration is carried out as a multiple doseregimen. In some embodiments, the multiple dose regimen is a time periodof up to about one month. In some embodiments of the present disclosure,the multiple dose regimen is a time period of up to about two months. Insome embodiments of the present disclosure, the multiple dose regimen isa time period of up to about three months. In some embodiments of thepresent disclosure, the multiple dose regimen is a time period of up toabout four months. Other time periods may be used herein.

In some embodiments, the administration is carried out one or more timesper day. In some embodiments, the administration is carried out one timeper day. In some embodiments, the administration is carried out twotimes per day. In some embodiments, the administration is carried outthree times per day. In some embodiments, the administration is carriedout four times per day.

The present disclosure also provides a method of treating a urinarytract infection in a patient in need thereof. In some embodiments, themethod comprises administering an effective amount of a compound of thepresent disclosure, or a pharmaceutically acceptable salt thereof, tothe patient. As used herein, the term “urinary tract” refers to theorgans of a patient's body that produce, store, and discharge urine andincludes without limitation the kidneys, ureters, bladder, and urethra.As used herein, the term “urinary tract infection” refers to aninfection of the urinary tract of a patient and includes withoutlimitation an uncomplicated urinary tract infection and a complicatedurinary tract infection. As used herein, the term “uncomplicated urinarytract infection” refers to an infection by a microbe of a structurallyand functionally normal urinary tract of a patient. As used herein, theterm “complicated urinary tract infection” refers to an infection by amicrobe of an abnormal structural and functional urinary tract of apatient. In some embodiments, the complicated urinary tract infection isa catheter-associated urinary tract infection. As used herein, the term“catheter-associated urinary tract infection” refers to a complicatedurinary tract infection that occurs in a patient having an indwellingurinary catheter.

In some embodiments, the patient is a human. In some embodiments, theadministration is intravesical administration. In some embodiments, theadministration is carried out using a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, in a liquidsolution or suspension. In some embodiments, the patient is administeredat least one additional active ingredient. In some embodiments, theadministration is carried out as a multiple dose regimen. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 2 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 3days. In some embodiments of the present disclosure, the multiple doseregimen is a time period of up to about 4 days. In some embodiments ofthe present disclosure, the multiple dose regimen is a time period of upto about 5 days. In some embodiments of the present disclosure, themultiple dose regimen is a time period of up to about 6 days. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 7 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 14days. In some embodiments of the present disclosure, the administrationis carried out as a chronic treatment regimen. Other time periods may beused herein.

In some embodiments, the administration is carried out one or more timesper day. In some embodiments, the administration is carried out one timeper day. In some embodiments, the administration is carried out twotimes per day. In some embodiments, the administration is carried outthree times per day. In some embodiments, the administration is carriedout four times per day.

The present disclosure also provides a method of treating a lunginfection in a patient in need thereof. In some embodiments, the methodcomprises administering an effective amount of a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, to thepatient. As used herein, the term “lung infection” refers to aninfection of one or both of a patient's lungs. In some embodiments, thelung infection arises from a pulmonary condition. As used herein, theterm “pulmonary condition” refers to both infection and non-infectioninduced disease and dysfunction of the respiratory system.

Non-limiting examples of pulmonary conditions include without limitationgenetic conditions, acquired conditions, primary conditions, secondaryconditions, asthma, chronic obstructive pulmonary disease, cysticfibrosis, bronchiolitis, pneumonia, bronchitis, emphysema, adultrespiratory distress syndrome, allergies, lung cancer, small cell lungcancer, primary lung cancer, metastatic lung cancer, brochiectasis,bronchopulmonary dysplasia, chronic bronchitis, chronic lowerrespiratory diseases, croup, high altitude pulmonary edema, pulmonaryfibrosis, interstitial lung disease, reactive airway disease,lymphangioleiomyomatosis, neonatal respiratory distress syndrome,parainfluenza, pleural effusion, pleurisy, pneumothorax, primarypulmonary hypertension, psittacosis, pulmonary edema secondary tovarious causes, pulmonary embolism, pulmonary hypertension secondary tovarious causes, respiratory failure secondary to various causes, sleepapnea, sarcoidosis, smoking, stridor, acute respiratory distresssyndrome, infectious diseases, SARS, tuberculosis, psittacosisinfection, Q fever, parainfluenza, respiratory syncytial virus,combinations thereof, and conditions caused by any one or combination ofthe above.

In some embodiments of the present disclosure, a method of treating alung infection arising from cystic fibrosis in a patient in need thereofis provided. In some embodiments, the method comprises administering aneffective amount of a compound of the present disclosure, or apharmaceutically acceptable salt thereof, to the patient. As usedherein, the term “cystic fibrosis” refers to a genetic disease thatcauses the production of abnormally thick mucus resulting in lunginfections and damage to the lungs, digestive system, and other organsin a patient's body.

In some embodiments, the administration is inhalation administration. Insome embodiments, the patient is administered at least one additionalactive ingredient. In some embodiments, the patient is a human. In someembodiments, the administration is carried out using a compound of thepresent disclosure, or a pharmaceutically acceptable salt thereof, in aliquid solution, suspension or dry powder. In some embodiments, theadministration is carried out as a multiple dose regimen. In someembodiments, the multiple dose regimen is a time period of up to aboutone month. In some embodiments of the present disclosure, the multipledose regimen is a time period of up to about two months. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about three months. In some embodiments of thepresent disclosure, the multiple dose regimen is a time period of up toabout four months. In some embodiments of the present disclosure, themultiple dose regimen is a time period of up to about five months. Insome embodiments of the present disclosure, the multiple dose regimen isa time period of up to about six months. In some embodiments of thepresent disclosure, the multiple dose regimen is a time period of up toabout seven months. In some embodiments of the present disclosure, themultiple dose regimen is a time period of up to about eight months.Other time periods may be used herein.

In some embodiments, the administration is carried out one or more timesper day. In some embodiments, the administration is carried out one timeper day. In some embodiments, the administration is carried out twotimes per day. In some embodiments, the administration is carried outthree times per day. In some embodiments, the administration is carriedout four times per day.

In some embodiments of the present disclosure, a method of treatingpneumonia in a patient in need thereof is provided. In some embodiments,the method comprises administering an effective amount of a compound ofthe present disclosure, or a pharmaceutically acceptable salt thereof,to the patient. As used herein, the term “pneumonia” refers to aninfection by a microbe of one or both lungs of a patient resulting ininflammation of lung tissue. In some embodiments, the pneumonia isventilator acquired pneumonia. As used herein, the term “ventilatoracquired pneumonia” refers to pneumonia arising from a patient beingconnected to a mechanical ventilation machine. Ventilator acquiredpneumonia includes pneumonia occurring more than about 48 hours after apatient has been intubated and received mechanical ventilation.

In some embodiments, the administration is inhalation administration. Insome embodiments, the patient is administered at least one additionalactive ingredient. In some embodiments, the patient is a human. In someembodiments, the administration is carried out using a compound of thepresent disclosure, or a pharmaceutically acceptable salt thereof, in aliquid solution, suspension or dry powder. In some embodiments, theadministration is carried out as a multiple dose regimen. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 7 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 14days. In some embodiments of the present disclosure, the multiple doseregimen is a time period of up to about 21 days. In some embodiments,the multiple dose regimen is a time period of up to about one month. Insome embodiments of the present disclosure, the multiple dose regimen isa time period of up to about two months. Other time periods may be usedherein.

In some embodiments, the administration is carried out one or more timesper day. In some embodiments, the administration is carried out one timeper day. In some embodiments, the administration is carried out twotimes per day. In some embodiments, the administration is carried outthree times per day. In some embodiments, the administration is carriedout four times per day.

The present disclosure also provides a method of treating an infectionin a burn wound in a patient in need thereof. In some embodiments, themethod comprises administering an effective amount of a compound of thepresent disclosure, or a pharmaceutically acceptable salt thereof, tothe patient. As used herein, the term “burn wound” refers to a burninjury to a patient's body involving damage to a patient's skin andpossibly tissues underlying the patient's skin. There are three primarytypes of burn levels known to one of skill in the art, including withoutlimitation first, second, and third degree burns. In some embodiments,the method of treating an infection in a burn wound contemplated by thepresent disclosure is used to treat a first, second, and/or third degreeburn.

In some embodiments, the patient is a human. In some embodiments, theadministration is topical administration. In some embodiments, theadministration is carried out using a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, in lotion,gel, cream, ointment, oil, solution, suspension, emulsion or otherviscous composition. In some embodiments, the patient is administered atleast one additional active ingredient. In some embodiments, theadministration is carried out as a multiple dose regimen. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 2 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 3days. In some embodiments of the present disclosure, the multiple doseregimen is a time period of up to about 4 days. In some embodiments ofthe present disclosure, the multiple dose regimen is a time period of upto about 5 days. In some embodiments of the present disclosure, themultiple dose regimen is a time period of up to about 6 days. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 7 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 14days. In some embodiments of the present disclosure, the multiple doseregimen is a time period of up to about 21 days. In some embodiments,the multiple dose regimen is a time period of up to about one month. Insome embodiments, the multiple dose regimen is a time period of up toabout two months. Other time periods may be used herein.

In some embodiments, the administration is carried out one or more timesper day. In some embodiments, the administration is carried out one timeper day. In some embodiments, the administration is carried out twotimes per day. In some embodiments, the administration is carried outthree times per day. In some embodiments, the administration is carriedout four times per day.

The present disclosure also provides a method of treating otitis externain a patient in need thereof. In some embodiments, the method comprisesadministering an effective amount of a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, to thepatient. As used herein, the term “otitis externa” refers to aninfection of the external ear canal of a patient.

In some embodiments, the patient is a human. In some embodiments, theadministration is topical administration directly into the patient'sexternal ear canal. In some embodiments, the administration is carriedout using a compound of the present disclosure, or a pharmaceuticallyacceptable salt thereof, in a liquid solution, suspension, lotion,paste, gel, cream, ointment, oil or other viscous composition. In someembodiments, the patient is administered at least one additional activeingredient. In some embodiments, the administration is carried out as amultiple dose regimen. In some embodiments of the present disclosure,the multiple dose regimen is a time period of up to about 7 days. Insome embodiments of the present disclosure, the multiple dose regimen isa time period of up to about 14 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 21days. In some embodiments, the multiple dose regimen is a time period ofup to about one month. Other time periods may be used herein.

In some embodiments, the administration is carried out one or more timesper day. In some embodiments, the administration is carried out one timeper day. In some embodiments, the administration is carried out twotimes per day. In some embodiments, the administration is carried outthree times per day. In some embodiments, the administration is carriedout four times per day.

The present disclosure also provides a method of treating bacterialvaginosis in a patient in need thereof. In some embodiments, the methodcomprises administering an effective amount of a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, to thepatient. As used herein, the term “bacterial vaginosis” refers to aninfection of the vagina of a patient caused by an overgrowth of bacterianaturally found in the vagina.

In some embodiments, the patient is a female human. In some embodiments,the administration is topical administration. In some embodiments, theadministration is carried out using a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, in a lotion,gel, cream, ointment, oil, solution, suspension, emulsion or otherviscous composition. In some embodiments, the patient is administered atleast one additional active ingredient. In some embodiments, theadministration is carried out as a multiple dose regimen. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 7 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 14days. In some embodiments of the present disclosure, the multiple doseregimen is a time period of up to about 21 days. In some embodiments,the multiple dose regimen is a time period of up to about one month.Other time periods may be used herein.

In some embodiments, the administration is carried out one or more timesper day. In some embodiments, the administration is carried out one timeper day. In some embodiments, the administration is carried out twotimes per day. In some embodiments, the administration is carried outthree times per day. In some embodiments, the administration is carriedout four times per day.

The present disclosure also provides a method of treating impetigo in apatient in need thereof. In some embodiments, the method comprisesadministering an effective amount of a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, to thepatient. As used herein, the term “impetigo” refers an infection of theskin of a patient that results in vesicles, pustules, yellowish crusts,and the like.

In some embodiments, the patient is a human. In some embodiments, theadministration is topical administration. In some embodiments, theadministration is carried out using a compound of the presentdisclosure, or a pharmaceutically acceptable salt thereof, in a lotion,gel, cream, ointment, oil, solution, suspension, emulsion or otherviscous composition. In some embodiments, the patient is administered atleast one additional active ingredient. In some embodiments, theadministration is carried out as a multiple dose regimen. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 2 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 3days. In some embodiments of the present disclosure, the multiple doseregimen is a time period of up to about 4 days. In some embodiments ofthe present disclosure, the multiple dose regimen is a time period of upto about 5 days. In some embodiments of the present disclosure, themultiple dose regimen is a time period of up to about 6 days. In someembodiments of the present disclosure, the multiple dose regimen is atime period of up to about 7 days. In some embodiments of the presentdisclosure, the multiple dose regimen is a time period of up to about 14days. In some embodiments of the present disclosure, the multiple doseregimen is a time period of up to about 21 days. In some embodiments,the multiple dose regimen is a time period of up to about one month.Other time periods may be used herein.

In some embodiments, the administration is carried out one or more timesper day. In some embodiments, the administration is carried out one timeper day. In some embodiments, the administration is carried out twotimes per day. In some embodiments, the administration is carried outthree times per day. In some embodiments, the administration is carriedout four times per day.

The present disclosure also provides a kit. In some embodiments, the kitcomprises a compound according to the present disclosure, or apharmaceutically acceptable salt thereof, or a pharmaceuticalcomposition according to the present disclosure. As used herein, theterm “kit” refers to any manufacture, such as, for example, a package,container, and the like, containing a compound according to the presentdisclosure, or a pharmaceutically acceptable salt thereof, or apharmaceutical composition according to the present disclosure. In someembodiments, a compound according to the present disclosure, or apharmaceutically acceptable salt thereof, or a pharmaceuticalcomposition according to the present disclosure is packaged in a vial,bottle, tube, flask or patch, which may be further packaged within abox, envelope, bag, or the like. In some embodiments, a compoundaccording to the present disclosure, or a pharmaceutically acceptablesalt thereof, or a pharmaceutical composition according to the presentdisclosure is approved by the U.S. Food and Drug Administration orsimilar regulatory agency in the U.S. or a jurisdiction or territoryoutside the U.S. for administration to a patient. In some embodiments,the kit includes written instructions for use and/or other indicationthat a compound according to the present disclosure, or apharmaceutically acceptable salt thereof, or a pharmaceuticalcomposition according to the present disclosure is suitable or approvedfor administration to a patient. In some embodiments, a compound orcomposition of the present disclosure is packaged in unit dose or singleunit dose form, such as, for example, single unit dose pills, capsulesor the like. In some embodiments, the kit includes a dispenser.

The present disclosure also provides the use of a compound of thepresent disclosure, or a pharmaceutically acceptable salt thereof, forthe manufacture of a medicament. As used herein, the term “medicament”refers to a pharmaceutical composition according to the presentdisclosure. In some embodiments, the pharmaceutical composition iscontained in any manufacture, such as, for example, a package,container, and the like.

In addition to the aspects and embodiments described and providedelsewhere in the present disclosure, the following non-limiting list ofembodiments are also contemplated.

1. A compound having the formula:

or a pharmaceutically acceptable salt thereof.

2. The pharmaceutically acceptable salt of the compound according toclause 1 selected from the group consisting of an ammonium salt, acalcium salt, a sodium salt, a potassium salt, a magnesium salt, and acobalt salt.

3. The pharmaceutically acceptable salt according to clause 2, whereinthe ammonium salt is ammonium ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate.

4. The pharmaceutically acceptable salt according to clause 2, whereinthe calcium salt is calcium((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate.

5. The pharmaceutically acceptable salt according to clause 2, whereinthe sodium salt is sodium ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate.

6. The pharmaceutically acceptable salt according to clause 2, whereinthe potassium salt is potassium ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate.

7. The pharmaceutically acceptable salt according to clause 2, whereinthe magnesium salt is magnesium ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate.

8. The pharmaceutically acceptable salt according to clause 2, whereinthe cobalt salt is cobalt ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methylbutyl phosphate.

9. The compound according to any one of clauses 1 to 8, or apharmaceutically acceptable salt thereof, wherein the compound, or apharmaceutically acceptable salt thereof, is a protonated compoundhaving a pH when dissolved in water of about pH 3 to about pH 5.

10. The compound according to any one of clauses 1 to 9, or apharmaceutically acceptable salt thereof, wherein the compound, or apharmaceutically acceptable salt thereof, is a protonated compoundhaving a pH when dissolved in water of about pH 3 to about pH 4.

11. A pharmaceutical composition comprising a compound according to anyone of clauses 1 to 10, or a pharmaceutically acceptable salt thereof,and one or more pharmaceutically acceptable carriers, excipients, ordiluents.

12. The pharmaceutical composition of clause 11, wherein thepharmaceutical composition includes at least one additional activeingredient.

13. The pharmaceutical composition of clause 11 or clause 12, whereinthe pharmaceutical composition is a human pharmaceutical composition.

14. The pharmaceutical composition of any one of clauses 11 to 13,wherein the pharmaceutical composition is adapted for topicaladministration.

15. The pharmaceutical composition of any one of clauses 11 to 14,wherein the pharmaceutical composition is administered in the form of alotion, gel, cream, ointment, oil, solution, suspension, emulsion orother viscous composition.

16. The pharmaceutical composition of any one of clauses 11 to 15,wherein the pharmaceutical composition is administered in the form of agel including a polyhydric alcohol.

17. The pharmaceutical composition of any one of clauses 11 to 13,wherein the pharmaceutical composition is adapted for oraladministration.

18. The pharmaceutical composition of clause 17, wherein thepharmaceutical composition is administered in the form of a capsule,tablet, powder, liquid suspension, solution, elixir, syrup orconcentrated drop.

19. The pharmaceutical composition of any one of clauses 11 to 13,wherein the pharmaceutical composition is adapted for inhalationadministration.

20. The pharmaceutical composition of clause 19, wherein thepharmaceutical composition is administered in the form of a dry powder,solution, suspension or aerosol.

21. The pharmaceutical composition of any one of clauses 11 to 13,wherein the pharmaceutical composition is adapted for intravesicaladministration.

22. The pharmaceutical composition of clause 21, wherein thepharmaceutical composition is administered via a catheter.

23. The pharmaceutical composition of any one of clauses 11 to 13,wherein the pharmaceutical composition is adapted for parenteraladministration.

24. The pharmaceutical composition of clause 23, wherein thepharmaceutical composition is administered via a needle.

25. A method of treating an infection of a diabetic foot ulcer in apatient in need thereof, the method comprising administering aneffective amount of a compound according to any one of clauses 1 to 10,or a pharmaceutically acceptable salt thereof, to the patient.

26. The method of clause 25, wherein the administration is topicaladministration.

27. The method of clause 25 or clause 26, wherein the administration iscarried out using the compound, or a pharmaceutically acceptable saltthereof, in a lotion, paste, gel, cream, ointment, oil or other viscouscomposition.

28. The method of any one of clauses 25 to 27, wherein theadministration is carried out using the compound, or a pharmaceuticallyacceptable salt thereof, in a gel.

29. The method of any one of clauses 25 to 28, wherein the patient isadministered at least one additional active ingredient.

30. The method of any one of clauses 25 to 29, wherein the patient is ahuman.

31. The method of any one of clauses 25 to 30, wherein theadministration is carried out as a multiple dose regimen.

32. The method of clause 31, wherein the multiple dose regimen is a timeperiod of up to about one month.

33. The method of clause 31, wherein the multiple dose regimen is a timeperiod of up to about two months.

34. The method of clause 31, wherein the multiple dose regimen is a timeperiod of up to about three months.

35. The method of clause 31, wherein the multiple dose regimen is a timeperiod of up to about four months.

36. The method of any one of clauses 25 to 35, wherein theadministration is carried out one time per day.

37. A method of treating a complicated urinary tract infection in apatient in need thereof, the method comprising administering aneffective amount of a compound according to any one of clauses 1 to 10,or a pharmaceutically acceptable salt thereof, to the patient.

38. The method of clause 37, wherein the urinary tract infection is acatheter-associated urinary tract infection.

39. The method of clause 37 or clause 38, wherein the administration isintravesical administration.

40. The method of any one of clauses 37 to 39, wherein theadministration is carried out using the compound, or a pharmaceuticallyacceptable salt thereof, in a liquid solution or suspension.

41. The method of any one of clauses 37 to 40, wherein the patient isadministered at least one additional active ingredient.

42. The method of any one of clauses 37 to 41, wherein the patient is ahuman.

43. The method of any one of clauses 37 to 42, wherein theadministration is carried out as a multiple dose regimen.

44. The method of clause 43, wherein the multiple dose regimen is a timeperiod of up to about 2 days.

45. The method of clause 43, wherein the multiple dose regimen is a timeperiod of up to about 3 days.

46. The method of clause 43, wherein the multiple dose regimen is a timeperiod of up to about 4 days.

47. The method of clause 43, wherein the multiple dose regimen is a timeperiod of up to about 5 days.

48. The method of clause 43, wherein the multiple dose regimen is a timeperiod of up to about 6 days.

49. The method of clause 43, wherein the multiple dose regimen is a timeperiod of up to about 7 days.

50. The method of clause 43, wherein the multiple dose regimen is a timeperiod of up to about 14 days.

51. The method of any one of clauses 37 to 41, wherein theadministration is carried out as a chronic treatment regimen.

52. The method of any one of clauses 37 to 51, wherein theadministration is carried out one time per day.

53. A method of treating a lung infection arising from cystic fibrosisin a patient in need thereof, the method comprising administering aneffective amount of a compound according to any one of clauses 1 to 10,or a pharmaceutically acceptable salt thereof, to the patient.

54. The method of clause 53, wherein the administration is inhalationadministration.

55. The method of clause 53 or 54, wherein the administration is carriedout using the compound, or a pharmaceutically acceptable salt thereof,in a dry powder, solution, suspension or aerosol.

56. The method of any one of clauses 53 to 55, wherein the patient isadministered at least one additional active ingredient.

57. The method of any one of clauses 53 to 56, wherein the patient is ahuman.

58. The method of any one of clauses 53 to 57, wherein theadministration is carried out as a multiple dose regimen.

59. The method of clause 58, wherein the multiple dose regimen is a timeperiod of up to about one month.

60. The method of clause 58, wherein the multiple dose regimen is a timeperiod of up to about two months.

61. The method of clause 58, wherein the multiple dose regimen is a timeperiod of up to about three months.

62. The method of clause 58, wherein the multiple dose regimen is a timeperiod of up to about four months.

63. The method of clause 58, wherein the multiple dose regimen is a timeperiod of up to about five months.

64. The method of clause 58, wherein the multiple dose regimen is a timeperiod of up to about six months.

65. The method of clause 58, wherein the multiple dose regimen is a timeperiod of up to about seven months.

66. The method of clause 58, wherein the multiple dose regimen is a timeperiod of up to about eight months.

67. The method of any one of clauses 53 to 58, wherein theadministration is carried out one time per day.

68. A method of treating ventilator acquired pneumonia in a patient inneed thereof, the method comprising administering an effective amount ofa compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, to the patient.

69. The method of clause 68, wherein the administration is inhalationadministration.

70. The method of clause 68 or clause 69, wherein the administration iscarried out using the compound, or a pharmaceutically acceptable saltthereof, in a liquid solution, suspension or dry powder.

71. The method of any one of clauses 68 to 70, wherein the patient isadministered at least one additional active ingredient.

72. The method of any one of clauses 68 to 71, wherein the patient is ahuman.

73. The method of any one of clauses 68 to 72, wherein theadministration is carried out as a multiple dose regimen.

74. The method of clause 73, wherein the multiple dose regimen is a timeperiod of up to about 7 days.

75. The method of clause 73, wherein the multiple dose regimen is a timeperiod of up to about 14 days.

76. The method of clause 73, wherein the multiple dose regimen is a timeperiod of up to about 21 days.

77. The method of clause 73, wherein the multiple dose regimen is a timeperiod of up to about one month.

78. The method of any one of clauses 68 to 73, wherein theadministration is carried out one time per day.

79. A method of treating an infection in a burn wound in a patient inneed thereof, the method comprising administering an effective amount ofa compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, to the patient.

80. The method of clause 79, wherein the administration is topicaladministration.

81. The method of clause 79 or 80, wherein the administration is carriedout using the compound in a lotion, gel, cream, ointment, oil, solution,suspension, emulsion or other viscous composition.

82. The method of any one of clauses 79 to 81, wherein the patient isadministered at least one additional active ingredient.

83. The method of any one of clauses 79 to 82, wherein the patient is ahuman.

84. The method of any one of clauses 79 to 83, wherein theadministration is carried out as a multiple dose regimen.

85. The method of clause 84, wherein the multiple dose regimen is a timeperiod of up to about 2 days.

86. The method of clause 84, wherein the multiple dose regimen is a timeperiod of up to about 3 days.

87. The method of clause 84, wherein the multiple dose regimen is a timeperiod of up to about 4 days.

88. The method of clause 84, wherein the multiple dose regimen is a timeperiod of up to about 5 days.

89. The method of clause 84, wherein the multiple dose regimen is a timeperiod of up to about 6 days.

90. The method of clause 84, wherein the multiple dose regimen is a timeperiod of up to about 7 days.

91. The method of clause 84, wherein the multiple dose regimen is a timeperiod of up to about 14 days.

92. The method of clause 84, wherein the multiple dose regimen is a timeperiod of up to about 21 days.

93. The method of clause 84, wherein the multiple dose regimen is a timeperiod of up to about one month.

94. The method of any one of clauses 84 to 93, wherein theadministration is carried out one or more times per day.

95. The method of any one of clauses 84 to 94, wherein theadministration is carried out one time per day.

96. The method of any one of clauses 84 to 94, wherein theadministration is carried out two times per day.

97. The method of any one of clauses 84 to 94, wherein theadministration is carried out three times per day.

98. The method of any one of clauses 84 to 94, wherein theadministration is carried out four times per day.

99. A method of treating otitis externa in a patient in need thereof,the method comprising administering an effective amount of a compoundaccording to any one of clauses 1 to 10, or a pharmaceuticallyacceptable salt thereof, to the patient.

100. The method of clause 99, wherein the administration is topicaladministration directly into the patient's external ear canal.

101. The method of clause 99 or clause 100, wherein the administrationis carried out using the compound in a lotion, gel, cream, ointment,oil, solution, suspension, emulsion or other viscous composition.

102. The method of any one of clauses 99 to 101, wherein the patient isadministered at least one additional active ingredient.

103. The method of any one of clauses 99 to 102, wherein the patient isa human.

104. The method of any one of clauses 99 to 103, wherein theadministration is carried out as a multiple dose regimen.

105. The method of clause 104, wherein the multiple dose regimen is atime period of up to about 7 days.

106. The method of clause 104, wherein the multiple dose regimen is atime period of up to about 14 days.

107. The method of clause 104, wherein the multiple dose regimen is atime period of up to about 21 days.

108. The method of clause 104, wherein the multiple dose regimen is atime period of up to about one month.

109. The method of any one of clauses 99 to 108, wherein theadministration is carried out one or more times per day.

110. The method of any one of clauses 99 to 109, wherein theadministration is carried out one time per day.

111. The method of any one of clauses 99 to 109, wherein theadministration is carried out two times per day.

112. The method of any one of clauses 99 to 109, wherein theadministration is carried out three times per day.

113. A method of treating bacterial vaginosis in a patient in needthereof, the method comprising administering an effective amount of acompound according to any one of clauses 1 to 10, or a pharmaceuticallyacceptable salt thereof, to the patient.

114. The method of clause 113, wherein the administration is topicaladministration.

115. The method of clause 113 or clause 114, wherein the administrationis carried out using the compound in a lotion, gel, cream, ointment,oil, solution, suspension, emulsion or other viscous composition.

116. The method of any one of clauses 113 to 115, wherein theadministration is carried out using a gel.

117. The method of any one of clauses 113 to 116, wherein the patient isadministered at least one additional active ingredient.

118. The method of any one of clauses 113 to 117, wherein the patient isa female human.

119. The method of any one of clauses 113 to 118, wherein theadministration is carried out as a multiple dose regimen.

120. The method of clause 119, wherein the multiple dose regimen is atime period of up to about 7 days.

121. The method of clause 119, wherein the multiple dose regimen is atime period of up to about 14 days.

122. The method of clause 119, wherein the multiple dose regimen is atime period of up to about 21 days.

123. The method of any one of clauses 113 to 122, wherein theadministration is carried out one or more times per day.

124. The method of any one of clauses 113 to 123, wherein theadministration is carried out one time per day.

125. A method of treating impetigo in a patient in need thereof, themethod comprising administering an effective amount of a compoundaccording to any one of clauses 1 to 10, or a pharmaceuticallyacceptable salt thereof, to the patient.

126. The method of clause 125, wherein the administration is topicaladministration.

127. The method of clause 125 or clause 126, wherein the administrationis carried out using the compound in a lotion, gel, cream, ointment,oil, solution, suspension, emulsion or other viscous composition.

128. The method of any one of clauses 125 to 127, wherein theadministration is carried out using a gel.

129. The method of any one of clauses 125 to 128, wherein the patient isadministered at least one additional active ingredient.

130. The method of any one of clauses 125 to 129, wherein the patient isa human.

131. The method of any one of clauses 125 to 130, wherein theadministration is carried out as a multiple dose regimen.

132. The method of clause 131, wherein the multiple dose regimen is atime period of up to about 2 days.

133. The method of clause 131, wherein the multiple dose regimen is atime period of up to about 3 days.

134. The method of clause 131, wherein the multiple dose regimen is atime period of up to about 4 days.

135. The method of clause 131, wherein the multiple dose regimen is atime period of up to about 5 days.

136. The method of clause 131, wherein the multiple dose regimen is atime period of up to about 6 days.

137. The method of clause 131, wherein the multiple dose regimen is atime period of up to about 7 days.

138. The method of clause 131, wherein the multiple dose regimen is atime period of up to about 14 days.

139. The method of clause 131, wherein the multiple dose regimen is atime period of up to about 21 days.

140. The method of any one of clauses 125 to 139, wherein theadministration is carried out one or more times per day.

141. The method of any one of clauses 125 to 140, wherein theadministration is carried out one time per day.

142. The method of any one of clauses 125 to 141, wherein theadministration is carried out two times per day.

143. A kit comprising the compound according to any one of clauses 1 to10, or a pharmaceutically acceptable salt thereof, or a pharmaceuticalcomposition according to any one of clauses 11 to 24.

144. A compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for use in therapy.

145. A compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for use in the treatment of aninfection of a diabetic foot ulcer.

146. A compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for use in the treatment of acomplicated urinary tract infection.

147. A compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for use in the treatment of alung infection arising from cystic fibrosis.

148. A compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for use in the treatment ofventilator acquired pneumonia.

149. A compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for use in the treatment of aninfection in a burn wound.

150. A compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for use in the treatment ofotitis externa.

151. A compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for use in the treatment ofbacterial vaginosis.

152. A compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for use in the treatment ofimpetigo.

153. The use of a compound according to any one of clauses 1 to 10, or apharmaceutically acceptable salt thereof, for the manufacture of amedicament.

154. A method of coating a catheter with a compound according to any oneof clauses 1 to 10, or a pharmaceutically acceptable salt thereof, themethod comprising coating the catheter with the compound, or apharmaceutically acceptable salt thereof, prior to inserting thecatheter into a patient.

155. A composition comprising a catheter coated with a compoundaccording to any one of clauses 1 to 10, or a pharmaceuticallyacceptable salt thereof.

EXAMPLES

Examples related to the present disclosure are described below. In mostcases, alternative techniques can be used. The examples are intended tobe illustrative and are not limiting or restrictive of the scope of theinvention as set forth in the claims.

Example 1 Synthesis of Nu-8

Step-1. Protection of the Amine (Building Block Key Intermediate)

Cytidine 2a is added to hexamethyldisilazane (HMDS),4-(dimethylamino)pyridine (DMAP), trimethylsilyltrifluoromethanesulfonate, and di-tert-butyl dicarbonate ((BOC)₂O) inmethanol to protect the nitrogen atoms of 2a by generating BOC-protectedcompound Int-2.

Step-2. Preparation of Phosphitylating Reagent (Building Block KeyIntermediate)

n-Butanol is reacted with the phosphinamide 1 in THF with tetrazole as acatalyst in the presence of N,N-diisopoylethylamine (DIEA). The crudeproduct is chromatographed on neutral alumina eluting with hexane andthen 2% ethyl acetate in hexane. The pure fractions is combined (by TLC)and evaporated to a residue under vacuo.

Step-3. Coupling of Key Intermediates

BOC-protected species Int-2 is bis-phosphitylated with reagent 2 indichloromethane (DCM)/dimethyl formamide (DMF) solvent and tetrazole ascatalyst to produce 3. The reaction mixture is concentrated to a residueand the crude product is immediately oxidized in the next step.

Steps 4 &5. Oxidation and Amino Deprotection

The crude product 3 is oxidized with tert-butylhydroperoxide (TBTH) inthe presence of decane to generate the bis-phosphonate species 4.Removal of the BOC groups is carried in DCM in the presence oftrifluoroacetic acid (TFA) to yield 5. The crude product ischromatographed on silica gel eluting with ethyl acetate. The purefractions (by TLC) are combined and evaporated to a residue under vacuo.

Step-6. Deprotection of the Phosphodiester

Hydrolysis of 5 with methanolic ammonium hydroxide (NH₄OH, MeOH) givescrude (I) ammonium salt (6).

Steps 7 & 8. Purification

Purification by preparative HPLC of 6 and conversion to the free acidwith Dowex 50WX8-200 resin is carried out. Evaporation of the aqueouseluate provides (I) that is diluted with purified water to provide a 20%solution at its ambient pH.

Example 2 Synthesis of Nu-8 Sodium Salt

Synthesis of Compound-2

To a solution of compound-1 (1.0 kg, 3.3222 mol) in THF (6 L) is addedDIEA (1.370 mL, 8.3055 mol) and tetrazole (230 g, 3.3222 mol) followedby n-butanol (275 mL, 2.99 mol) in THF (6 L) is added drop wise at 0° C.for 12 h. The reaction mixture is stirred at room temperature for 24 h.The progress of the reaction is monitored by TLC and after completion ofthe reaction, solid is filtered off. Filtrate is evaporated underreduced pressure at 40° C. to afford crude compound. Crude compound isdissolved in ethyl acetate (5 L). Organic layer is washed with water (3L) and brine (2 L). Organic layer is dried over anhydrous Na₂SO₄filtered and the solvent is evaporated under reduced pressure to obtaincrude compound. The crude compound is purified by column chromatographyover basic lumina (Al₂O₃), Compound eluted with 0-2% EtOAc in petroleumether to afford Compound-2. (700 g, 76.92%) as pale yellow liquid. H-NMR(400 MHz, chloroform-d) δ 4.18-4.07 (m, 1H), 4.02 (q, J=6.6 Hz, 1H),3.93-3.74 (m, 4H), 2.65 (td, J=6.5, 3.6 Hz, 2H), 1.31-1.23 (m, 4H), 1.18(dd, J=6.8, 3.8 Hz, 12H), 0.93 (td, J=7.4, 3.1 Hz, 3H). LC-MS: 275(M+H).

Synthesis of Compound-4

To solution of compound-3 (300 g, 1.321 mol) in hexamethyldisilazane(638 g, 3.964 mol) is added DMAP (16.11 g, 0.132 mol) followed by TMSOTf(7.22 g, 0.039 mol) is added at 0° C. and the resulting reaction mixtureis stirred for 1 h at room temperature. After complete of startingmaterial Boc-anhydride (1.4 L, 6.605 mol) is added at 0° C. for 1 h andthe reaction mixture is stirred for 16 h at room temperature. To thereaction is added methanol (3 L) followed by triethylamine (1.5 L) isadded at 0° C. for 1 h and the reaction mixture is stirred for 20 h atroom temperature. Reaction mixture is concentrated under reducedpressure to get crude compound. Crude compound is diluted with ethylacetate (3 L) and washed with water (1.0 L) and brine (1.0 L) solution;organic layer is dried over anhydrous Na₂SO₄, filtered and the solventis evaporated under reduced pressure to get afford crude compound. Thecrude compound is purified by column chromatography silica gel (100-200mesh) compound eluted 0-3% MeOH in DCM to afford Compound-4 (180 g,31.89%) as off white solid. H-NMR (300 MHz, DMSO-d6) δ 8.41 (d, J=7.5Hz, 1H), 6.84 (d, J=7.5 Hz, 1H), 6.06 (t, J=6.2 Hz, 1H), 5.28 (d, J=4.3Hz, 1H), 5.07 (q, J=4.6, 4.0 Hz, 1H), 4.21 (q, J=4.1 Hz, 1H), 3.87 (q,J=3.7 Hz, 1H), 3.71-3.49 (m, 2H), 2.32 (m, 1H), 2.03 (dt, J=13.0, 6.2Hz, 1H), 1.49 (s, 18H). LC-MS: 275 (M+H).

Synthesis of Compound-6

To a stirred solution of compound-4 (180 g, 0.421 mol) in THF (1.0 L) isadded DIEA (348 mL, 2.105 mol) and tetrazole (176 g, 2.526 mol) at 0° C.To the resulting reaction mixture is added a solution of compound-2 (519g, 1.896 mol) in THF (800 mL) drop wise at 0° C. for 1 h. The reactionmixture is stirred at room temperature for 16 h. After completion of thereaction, tert-butyl peroxide in decane (505 mL, 5 M) is added drop wiseat 0° C. and the reaction mixture is stirred for 6 h at roomtemperature. The reaction is monitored by TLC. After completion of thereaction, the reaction mixture is concentrated at 40° C. and dilutedwith ethyl acetate (3 L) and washed with water (1 L) and brine (1 L)solution. Organic layer is dried over anhydrous Na₂SO₄ filtered and thesolvent is evaporated under reduced pressure to get afford crudecompound (350 g crude). The crude compound is purified by columnchromatography through silica gel (100-200 mesh) column eluted with 0-5%MeOH in DCM. All collected pure fractions are concentrated to affordpure Compound-6 (220 g, 64.83%) as a wine red liquid. H-NMR (300 MHz,DMSO-d₆) δ 8.19 (dd, J=7.6, 1.3 Hz, 1H), 6.88 (d, J=7.5 Hz, 1H), 6.13(t, J=10.5 Hz, 1H), 4.99 (s, 1H), 4.44 (s, 1H), 4.26-3.96 (m, 10H),3.00-2.84 (m, 4H), 2.57-2.79 (m, 2H), 1.70-1.54 (m, 4H), 1.50 (s, 18H),1.35 (m, 4H), 0.88 (qd, J=7.5, 2.5 Hz, 6H); LC-MS: 806 (M+H).

Synthesis of Compound-7

To a solution of Compound-6 (220 g, 0.273 mol) in DCM (4.4 L) is addedTFA (210 mL, 2.732 mol) dropwise at 0° C. The reaction mixture isstirred at room temperature for 24 h. The reaction is monitored by TLC.After completion of the reaction, solvent is evaporated under reducedpressure to afford crude compound. The crude compound is purified bycolumn chromatography silica gel (230-400 mesh). Compound eluted with0-10% MeOH in DCM. All collected pure fractions are concentrated toafford pure Compound-7 (170 g, 84.67%) as a pale yellow liquid. H-NMR(300 MHz, DMSO-d₆) δ 7.61 (d, J=7.5 Hz, 1H), 7.27 (d, J=13.9 Hz, 2H),6.19 (t, J=6.9 Hz, 1H), 5.74 (d, J=7.4 Hz, 1H), 4.96 (s, 1H), 4.10-3.93(m, 11H), 2.93 (q, J=6.2 Hz, 4H), 2.29 (d, J=13.1 Hz, 2H), 1.61 (h,J=7.1 Hz, 4H), 1.35 (p, J=7.3 Hz, 4H), 0.89 (dq, J=7.9, 4.2 Hz, 6H);LC-MS: 606 (M+H).

Synthesis of Nu-8

To a stirred solution of Compound-7 (720 g, 1.1900 mol) in MeOH (5.0 L)is added aq. ammonia (600 mL) at 0° C. The reaction mixture is stirredat room temperature for 4 h. The reaction is monitored by TLC. Aftercompletion of the reaction, evaporate the MeOH under reduced pressurethe aqueous layer is washed with DCM (1.5 L). The aqueous layer ispassed through Dowex-H⁺ resin. The water is removed under reducedpressure to afford Nu-8 (260 g, 43.84%) as an off white solid. H-NMR(300 MHz, DMSO-d₆) δ 8.94 (s, 1H), 8.49 (s, 1H), 7.97 (d, J=7.8 Hz, 1H),6.08 (t, J=6.1 Hz, 1H), 5.95 (d, J=7.7 Hz, 1H), 4.76 (q, J=5.8 Hz, 1H),4.15 (q, J=4.1 Hz, 1H), 4.08 (s, 1H), 3.83 (m, 6H), 2.43 (t, J=5.6 Hz,2H), 1.67-1.44 (m, 4H), 1.44-1.26 (m, 4H), 0.95-0.82 (m, 6H), LC-MS:500.15 (M+H).

Synthesis of Nu-8 Sodium Salt

To a stirred solution of compound-Nu-8 (260 g, 0.478 mol) in water (2.6L), 1 N NaOH (950 mL) is added dropwise at 0° C. The reaction mixture isstirred at room temperature for 2 h. The reaction is monitored by TLC.After completion of the reaction, aqueous layer is washed with DCM (1.5L). The aqueous layer is evaporated under reduced pressure to affordNu-8 sodium salt (265 g, 93%) as off white solid. H-NMR (300 MHz,DMSO-d₆) δ 7.81 (d, J=7.2 Hz, 1H), 7.2 (bs, 1H), 7.0 (bs, 1H), 6.16 (t,J=4 Hz, 1H), 5.71 (d, J=7.6 Hz, 1H), 4.69 (bs, 1H), 3.75 (m, 1H), 3.71(m, 1H), 3.8 (m, 4H), 2.2 (q, 1H), 1.89-1.96-1.44 (m, 1H), 1.49-1.39 (m,4H), 1.34-1.23 (m, 4H), 0.88-0.84 (m, 6H).

Example 3 Comparative Physical Property Studies of Bisphosphocin®Compounds Nu-2, Nu-4, and Nu-5, and the Compound of Formula (I)

The structures of known Bisphosphocin® compounds Nu-2, Nu-4, and Nu-5are shown below:

pH studies are conducted to show the pH of Nu-8 compared toBisphosphocin® compounds Nu-2, Nu-4, and Nu-5. 20 mg/mL Nu-2 solution isprepared by diluting 2 mL of 250 mg/mL Nu-2 solution with 23 mL DIwater. 20 mg/mL Nu-4 and Nu-5 solutions are prepared in the same way.401.65 mg Nu-8 is weighed in a 5 mL volumetric flask and diluted with DIwater to volume. 20 mg/mL Nu-8 solution is prepared by diluting 5 mL of80.3 mg/mL Nu-8 solution with 15 mL DI water. The pH values of 4 Nu-2,Nu-4, Nu-5, and Nu-8 at 20 mg/mL are measured with a calibrated pHmeter. The results are shown in TABLE 1. Also shown in TABLE 1 is asummary of other physical properties of the compound of Formula (I) andreference compounds Nu-2, Nu-4, and Nu-5.

TABLE 1 Nu-2 Nu-4 Nu-5 Nu-8 pH (2% solution) 0.99 0.94 0.93 1.49 pKa2.30 2.30 2.28 3.20 Solubility — — — 137 Pow 0.0407 0.0592 0.0480 0.0662

Nu-8 prepared in a 2% aqueous solution provides the most basic (highestpH) solution compared to reference compounds Nu-2, Nu-4, and Nu-5.Without wishing to be bound to any particular theory, it is believedthat the presence of a free exocyclic amino group in the structure ofNu-8 alters the pH of Nu-8 in solution, which in turn caused Nu-8 to actmore rapidly and to be more potent at higher pH levels thanBisphosphocins® Nu-2, Nu-4, and Nu-5.

Additionally, pKa measurements show that Nu-8 has the lowest aciddissociation constant compared to Bisphosphocins® Nu-2, Nu-4, and Nu-5,which is a measurement of the dissociation of the molecule in tohydrogen ion(s) and corresponding conjugate base. Without wishing to bebound to any particular theory, it is believed that Nu-8 does not haveas many acidic protons in its structure that can dissociate intosolution as hydrogen ions compared to the number of acidic protonspresent in reference Bisphosphocin® compounds Nu-2, Nu-4, and Nu-5. Thereference Bisphosphocins® compounds have acidic protons such as hydroxylprotons and methyl ester protons, which can dissociate into solution.

In summary, Nu-8 prepared in a 2% aqueous solution provides the mostbasic (highest pH) solution and acts more rapidly and is more potent athigher pH levels compared to reference compounds Nu-2, Nu-4, and Nu-5.

Example 4 Use of Nu-8 in the Treatment of Helicobacter Pylon in Mice

Animals

The mouse strain used in this study is C57/BL6 ranging from 5-6 weeks inage and 18-22 grams in weight. Mice are housed five to a cage with freeaccess to food and water in accordance with NIH guidelines.

Bacterial Strain

A bacterial strain of Helicobacter pylori SS1 (CagA+, VacA+) is adaptedfor the mouse model from a human clinical isolate and validated in thisinfection model.

Infection

At 6 days prior to infection, a frozen stock is streaked onto one to twoColumbia 5% sheep blood agar plates, and the plates aremicroaerophilically incubated for 72 hours at 37° C. After 72 hours, theplate growth is subcultured onto five Columbia 5% sheep blood agarplates and is incubated as before. After another 72 hours of incubation,the plates are removed, and the plate growth is suspended in sterile0.9% saline to an OD of 1.5-2.0 at 530 nm. This OD is approximatelyequal to 1.0e+09 CFU/mL, which is used to orally infect the mice on all3 infection days. To infect mice, the mice are orally dosed 0.25 mL ofthe 1.0e+09 CFU/mL via a 20-22 G gavage needle. Mice need to be fastedonly before the first infection.

Treatment

At 1 week post-infection, mice are treated with Nu-8. Multiple doseantibiotic therapies are administered orally at 0.2 mL/dose. Antibioticsare administered 2 times per day and continued for 7 days. The controlgroup is administered the vehicle alone.

Sampling

Food is removed from cages 18 hours prior to euthanizing animals andeach cage is clearly labeled that the animals are being experimentallyfasted. Mice are euthanized (CO₂ & cervical dislocation). After mice areeuthanized, each stomach is removed by cutting the esophagus away fromthe superior aspect of the stomach and the duodenum away from thepyloric region. The excised stomach is placed into a sterile petri dishand the luminal contents are rinsed away with sterile 1×PBS. Each rinsedstomach is placed into a 14-mL Falcon tube containing 2 mL of 1×PBS andstored on ice. Each stomach is homogenized, 10-fold serial diluted in1×PBS, spot plated onto Columbia agar with 3.5% laked horse blood±theDENT selective antibiotic supplement, and microaerophilically incubatedfor 5 days at 37° C. Then, colonies are counted.

Dose Response

Nu-8 is administered at various doses (mg/kg), orally, twice-a-day for 7days. The formulations, concentration and dose volumes for treatment isestablished prior to dosing. The positive control group consists of atriple therapy regimen (omeprazole, amoxicillin, and clarithromycin).Negative control used dosing solution without drugs. The doing scheduleis shown in TABLE 2. The inoculation and treatment schedule is shown inTABLE 3.

TABLE 2 Conc Dose Group Compound Dose Volume Regimen # animals^(a) 1Nu-8 0.2 mg 1 mg/mL, PO; bid × 16 0.2 mL 7 days 2 1.0 mg 5 mg/mL, 16 0.2mL 3 2.0 mg 10 mg/mL, 16 0.2 mL 4 PrevPac 31 mg/kg 31 mg/kg bid × 7 days16 5 Vehicle na na bid × 7 days 5 6 Infection na na bid × 7 days 20controls ^(a)8 animals each for therapeutic and relapse endpoints

TABLE 3 Day Procedure −11 Infection −10 −9 Infection −8 −7 Infection 0Treatment & Control sample 1 Treatment 2 3 4 5 6 7 Day 7 sample 14 Day14 sampleResults

Mice are infected on three days with inoculums of 6.16, 6.6 and6.37_(log10) CFU. One week following the last infection (Day 0—treatmentinitiated) mean stomach titers are 6.74_(log10) CFU. Counts remainconsistent over the next two weeks with mean titers for the untreatedcontrol groups of 6.86 and 6.66_(log10) CFU on days 7 and 14,respectively (see TABLE 4, which shows mean bacterial stomach titers ofH. pylori SS1 in mice following treatment with Nu-8 and Prevpac). Nu-8exhibits a dose response with bacterial stomach tiers of 5.62, 5.21, and4.74 on Day 7 and 6.2, 5.67, and 5.81_(log10) CFU on Day 14 for the dosesolutions of 1, 5, and 10 mg/mL, respectively. Prevpac (e.g.,clarithromycin, omeprazole and Amoxicillin) reduces bacterial titers to3.22_(log10) CFU on Day 7 which rebounds to 6.19_(log10) CFU by Day 14.Although treatment with Nu-8 is less effective than the triple therapyregimen on Day 7, Nu-8 exhibits less of a rebound by Day 14 (7 daysafter the last administered dose) than Prevpac with lower counts for the5 and 10 mg/mL dose groups (see TABLE 4). In summary, these resultssupport the use of Nu-8 as a longer term treatment of H. pyloriinfections, which such results would be expected against other gramnegative bacteria.

TABLE 4 Conc Group Test Dose Dose Vol Regimen Time-points Log10 SD 1 Cp,[pim (I) 0.2 mg 1 mg/mL, PO, bid for  +7 Days 5.62 0.6 0.2 mL 7 days +14Days 6.2 0.86 2 1.0 mg 5 mg/mL, PO, bid for  +7 Days 5.21 0.26 0.2 mL 7days +14 Days 5.67 0.23 3 2 mg 10 mg/mL, PO, bid for  +7 Days 4.74 0.680.2 mL 7 days; +14 Days 5.81 0.74 4 PREVPAC 31 mg/kg 31 mg/kg PO, bidfor  +7 Days 3.22 0.52 7 days +14 Days 6.19 0.69 5 Vehicle na na PO, bidfor  +7 Days 6.59 0.12 Treated 7 days Day 0 6.74 0.37 6 Untreated na nana Controls na  +7 Days 6.86 0.54 na +14 Days 6.66 0.76

Example 5 Bacterial Cytological Profiling for Assessing StructureActivity Relationship of Nu-8 Compared with Bisphosphocin® CompoundsNu-3, Nu-4, and Nu-5

The structure of known Bisphosphocin® compound Nu-3 is shown below:

Methods and Materials

This bacterial cytological profiling (BCP) study uses methods andmaterials described previously by Nonejuie, P., Burkart, M., Poglianoa,K., Pogiano, J. (2013). Bacterial cytological profiling rapidlyidentifies the cellular pathways targeted by antibacterial molecules.Proc. Natl. Acad. Sci. U.S.A. 110(40):16169-16174. doi:10.1073/pnas.1311066110.

Wild type strains of E. coli ATCC 25922 or P. aeruginosa K2732 are grownin rich media (unbuffered 2× Lysogeny broth [LB]) at 30 C to anOD₆₀₀˜0.4. These cultures are then split and each sample treated withthe appropriate concentration of Nu-8 in unbuffered or buffered LB(final mixture OD₆₀₀˜0.1). Cells exposed without Nu-8 are buffered to pH4 with phosphoric acid.

The BCP is performed in LB media buffered to pH 4. The minimuminhibitory concentration (MIC) is measured for Nu-3, Nu-4, Nu-5, andNu-8 against each bacterial strain. As one of ordinary skill in the artunderstands, minimum inhibitory concentrations are the lowestconcentration of an antimicrobial that will inhibit the visible growthof a microorganism after overnight incubation. Cells are treated witheach of Nu-3, Nu-4, Nu-5, and Nu-8 at three different concentrations (1,0.5, and 0.25× MIC) and samples are collected at 30 min and 2 and 4 hfor imaging. Cellular viability is assayed at three time points (5minutes and 4 and 24 h following the onset of treatment).

For imaging E. coli, treated cells are stained with 1 μg/mL FM4-64, 2μg/mL DAPI, and 0.5 μM SYTOXGreen (Molecular Probes/Invitrogen). P.aeruginosa samples are stained 0.5 μM SYTOX Green, 28 μg/mL DAPI, and4.5 μg/mL FM 4-64. Cells are transferred to an agarose pad (20% LB, 1%agarose) for imaging as described in Pogliano, J., Osborne, N., Sharp,M. D., Abanes-De Mello, A., Perez, A., Sun, Y.-L. and Pogliano, K.(1999), A vital stain for studying membrane dynamics in bacteria: anovel mechanism controlling septation during Bacillus subtilissporulation. Molecular Microbiology, 31: 1149-1159. doi:10.1046/j0.1365-2958.1999.01255.x.

Results

The BCP results indicate that each of Nu-3, Nu-4, Nu-5, and Nu-8 affectthe cell envelope in both E. coli (ATCC 25922) and P. aeruginosa(K2732). Treatment with Nu-3, Nu-4, Nu-5, and Nu-8 causes DNAcondensation at higher treatment concentrations (buffered pH 4) for E.coli (ATCC 25922). Nu-4, Nu-5, and Nu-8 increase cell membranepermeability (buffered pH 4 or in unbuffered LB) for both E. coli (ATCC25922) and P. aeruginosa (K2732), while Nu-3, Nu-4, and Nu-5 cause cellwall deformations (unbuffered LB) for E. coli (ATCC 25922). Treatmentwith Nu-8 manifests rapid and marked reduction in cell viability and issuperior in effect to Nu-3, Nu-4, and Nu-5. Specifically, Nu-8 reducescell viability to <10² CFU/mL within minutes from an initial CFU/mL of10⁹. Nu-3, Nu-4 and Nu-5 also reduce CFU/mL to <10²⁻³ at a slower ratewithin hours of treatment.

In summary, these results support the use of Nu-8 in treatment ofinfection in which a fast acting antimicrobial mechanism is preferred,such as, for example, urinary tract infections and bacterial infectionsassociated with diabetic foot ulcers, among others.

Example 6 Bisphosphocin® Compounds Nu-3 and Nu-5 and Nu-8 AntimicrobialEfficacy at Incremental pH Increases Against E. coli and P. aeruginosa

MIC testing is conducted using the broth (Mueller Hinton Broth)microdilution procedures relevant to each organism group as establishedby the Clinical and Laboratory Standards Institute (CLSI; 3-7). MICplates are prepared in accordance with CLSI (3-7). To prepare the testplates, automated liquid handlers are used to conduct serial dilutionsand liquid transfers. Automated liquid handlers utilized in this studyinclude the Multidrop 384 (Labsystems, Helsinki, Finland) and the Biomek2000 (Beckman Coulter, Fullerton Calif.). The solution is diluted todesired pH using 1 M Citric Acid or 1 M NaOH buffer. A standardizedinoculum of each test organism is prepared per CLSI methods (3, 5-7) toequal a 0.5 McFarland standard in the appropriate media followed by anadditional 1:20 dilution (1:10 for anaerobes).

The plates are then inoculated with 10 μL of the diluted 0.5 McFarlandsuspension using the Biomek 2000 from low to high drug concentration,resulting in a final concentration of approximately 5×10⁵ CFU/mL perwell. An un-inoculated plate is incubated for the purpose of assessingsolubility of the drug in the test media. The plates are stacked 3 to 4high, covered with a sterile lid on the top plate, and incubated for 18to 24 hours according to CLSI. The MIC is recorded as the lowestconcentration of respective compound that inhibited visible growth ofthe organism.

As demonstrated in TABLE 5, Nu-8 MIC efficacy is greater thanBisphosphocin® Compounds Nu-3 and Nu-5 at equivalent pH against E. coliand P. aeruginosa. Specifically, Nu-8 antimicrobial activity is betterthan Nu-3 and Nu-5 in pH range (pH 3-4) deemed important for clinicaluse in several administration routes, such as, for example, topical,inhalation, and intravesical.

TABLE 5 pH 1 pH 3 pH 4 pH 5 pH 7 (MIC) mg/mL E. coli Nu-3 12.5 >100— >100 >100 Nu-5 6.25 100 — 100 100 Nu-8 9.8 37.5 75 >75 >75 P.aeruginosa Nu-3 12.5 >100 — >100 >100 Nu-5 6.25 100 — 100 100 Nu-8 9.3818.75 37.5 75 >75

Example 7 Bacterial Cytological Profiling of Nu-3 Versus Nu-8 AgainstGram Negative and Gram Positive Bacteria at pH 4, 5.5, and 7

Methods and Materials

This bacterial cytological profiling (BCP) investigation uses methodsand materials described previously by Nonejuie, P., Burkart, M.,Poglianoa, K., Pogiano, J. (2013). Bacterial cytological profilingrapidly identifies the cellular pathways targeted by antibacterialmolecules. Proc. Natl. Acad. Sci. U.S.A. 110(40):16169-16174. doi:10.1073/pnas.1311066110.

For viable cell counts, cells are grown to OD₆₀₀≈0.4 and diluted 1:1into buffered or unbuffered media containing various compoundconcentrations. Samples are then collected and serially diluted (1:10)on a 96 well plate. Five microliters from each well are spotted on LBplates, incubated at 30° C., and viable cells are counted the next day.

Samples are collected at 10, 30, 120, and 240 min of exposure for viablecell count and imaging. For imaging, E. coli and S. aureus 200 μL oftreated cells per time point are stained with 0.8 μg/mL FM4-64, 1.5μg/mL DAPI, and 0.4 μM SYTOXGreen (Molecular Probes/Invitrogen). P.aeruginosa samples are stained 0.4 μM SYTOX Green, 28 μg/mL DAPI, and 1μg/mL FM 4-64. Cells are transferred to an agarose pad (20% LB, 1%agarose) for imaging.

For Nu-3 and Nu-8 stocks (at pH 4, 5.5 and 7), stock concentration is500 mg/mL. For pH 4, the stocks are prepared by dissolving Nu-3 in 25 mMcitrate buffer and Nu-8 in 350 mM citric acid. For pH 5.5, the stocksare prepared by dissolving Nu-3 in 25 mM citric-phosphate and Nu-8 in 25mM critic. For pH 7, the stocks are prepared by dissolving Nu-3 and Nu-8in 25 mM Sorensen phosphate buffer. 2×LB (lysogeny broth) solutions areprepared with 50 mM citrate buffer for pH 4, 50 mM citrate-phosphatebuffer for pH 5.5, and 50 mM Sorensen phosphate buffer for pH 7.

Results

Under the experimental conditions of BCP procedure performed at pH 4 andabove, Nu-8 is more effective than Nu-3 (at equimolar concentrations)against wild type E. coli (ATCC 25922), wild type P. aeruginosa (PAO1;K2732), and methicillin susceptible S. aureus (ATCC 29213) in rapidlyaltering cell viability, cell growth, and cell permeability over a rangeof exposure times, concentrations, and in buffered media (LinnaeusBioscience Oct. 2, 2017 Report). E. coli in culture at pH 4, 5.5, and 7without treatment is unaffected. E. coli cell growth, cell viability,and cell permeability up to 24 h of the study remain consistent relativeto similar parameters assayed at neutral pH. At pH 4, Nu-8 is moreeffective than Nu-3 at similar concentrations (112.5 and 225 mg/mL)markedly decreasing cell viability within 10 min of treatment (cellviability decreases from log 10⁷ CFU/mL to <log 10³ CFU/mL), whereasNu-3 at 112.5 mg/mL slows cell growth during 240 min of treatmentleading to lower cell viability at 24 h (cell growth delay up to 240 min10⁷ CFR/mL [pH 4 alone, cell growth at 240 min 10⁸ CFU/mL] decreases to10^(4.5) CFU/mL by 24 h), and at 225 mg/mL reduces cell viability within240 min (<10³ CFU/mL). Cell viability occurs before apparent changes incell permeability are detected at 10 min of treatment. At pH 5.5 and 7,Nu-8 alters E. coli cell permeability and reduces cell viability andgrowth whereas Nu-3 is ineffective.

P. aeruginosa at pH 4 alone is rapidly affected with reduced cell growthand viability and increased maximal 100% cell permeability (within 10 to30 min of treatment). At pH 5.5 and 7 alone, cell growth and cellviability, and cell permeability are unaffected (relative to similarparameters assayed at neutral pH). Nu-3 and Nu-8 at pH 4 are generallyadditive in effect to that observed at pH 4 alone and reduce cellviability. Nu-8 at 56.5 mg/mL is more effective in reducing cellviability (<10³ CFU/mL) within 30 min relative to Nu-3 at twice theconcentration (112.5 mg/mL), which reduces cell viability within 120 min(<10³ CFU/mL). At 112.5 mg/mL, Nu-8 lowers cell viability within 10 min(<10³ CFU/mL) beyond that occurring with a similar Nu-3 treatment aswell as with pH 4 alone (˜10⁶ CFU/mL by 10 min). Also at pH 5.5 and 7,Nu-8 at 112.5 mg/mL is more active causing <20% increase in cellpermeability and reduction in cell growth relative to Nu-3 at 112.5mg/mL, which produces little change in cell permeability (<6%) and noeffect on cell growth. At pH 7, only Nu-8 (225 mg/mL) increases cellpermeability (˜37% with 10 min) which subsequently is not persistent andcell growth is slightly lower than that at pH 7 alone.

S. aureus at pH 4 alone exhibits reduced cell growth and cell viabilityand a slight increase in cell permeability (<8%). At pH 5.5 alone, cellgrowth is inhibited up to 240 min and later recovered by 24 h and cellpermeability is unaffected. At pH 7, all cell parameters are unaffected.At pH 4, Nu-8 at 125 mg/mL slightly increases cell permeability (<4.3%)with enhanced killing activity (10³ CFU/mL by 240 min from 10⁷⁵ CFU/mLat study start, and <10³ CFU/mL at 24 h) compared to cell viability atpH 4 alone (˜10⁷ CFU/mL at 240 min and 10⁴ CFU/mL at 24 h). Nu-3 at 125mg/mL produces low cell permeability (<10%) and slight reduction in cellgrowth resembling that at pH 4 alone. At 250 mg/mL, Nu-8 reduces cellviability within 10 min (˜10⁴ CFU/mL) without recovery later (<10³CFU/mL) and increases cell permeability (˜60%). Nu-3 at 250 mg/mL isless active producing a slight increase in cell permeability (<10%) withreduced cell viability within 240 min to 24 h (<10³ CFU/mL). At pH 5.5and 7, both Nu-3 and Nu-8 (125 mg/mL and 250 mg/mL) slightly reduce cellgrowth up to 24 h with minimal effect on cell permeability (<5%).

In summary, this study demonstrates that Nu-8 will outperform Nu-3across a pH range 3-4 planned for clinical use.

Example 8 Nu-8 Antimicrobial Activity Against Strain Commonly Associatedwith Bacteria

Bacterial strains evaluated in this study include Escherichia coli,Klebsiella spp, Serratia marcescens, Proteus mirabilis/vulgaris,Citrobacter spp, Providencia spp, Morganella morganii, Pseudomonasaeruginosa, Staphylococcus aureus (MRSA only), and Enterococcusfaecalis. Nu-8 test solutions are adjusted to pH 3.5 with citric acid,and MCI is evaluated per the CLSI methods in Mueller-Hinton brothsupplemented accordingly to facilitate growth of specific strains.

MICs of the Nu-8 at pH 3.5 are measured in human and mouse urine and arecomparable to those of Nu-8 in Mueller Hinton broth under similarconditions. TABLE 6 demonstrates Nu-8 MIC against the bacterial strainsidentified therein.

TABLE 6 Nu-8 MIC (mg/mL) at pH 3.5 Test Organisms (# of isolates) (MIC₅₀and MIC₉₀) Gram-negative Escherichia coli (5) 37.5 Klebsiella pneumoniae(5) (includes 37.5-75   Serratia marcescens (5) 37.5-75   Proteusmirabilis/vulgaris (5)  4.69-18.75 Citrobacter species (5) 18.75-37.5 Providencia species (5) 9.38-37.5 Morganella morganii (5) 18.75Haemophilus influenzae (5) 4.69-9.38 Other Pseudomonas aeruginosa (20)9.38-18.75 (18.75 and 18.75) Gram-positive Staphylococcus aureus (20)(MRSA 9.38-37.5 (18.75 and 37.5) Enterococcus faecalis (5) (both VSE 4.69-18.75 Streptococcus pneumoniae (PRSP)  9.38-18.75

The MICs are also determined using lysogeny broth (LB) at pH 4 as thegrowth medium. Under these conditions, Nu-8 is active against E. coliand P. aeruginosa with MICs of 54 and 27 mg/mL, respectively.

In summary, these results demonstrate that Nu-8 is effective againstgram negative and gram positive bacteria, which is deemed important forclinical use in several administration routes, such as, for example,topical, inhalation, and intravesical.

Example 9 Initial Efficacy Evaluation of Nu-8 Against Escherichia Coliin a Urinary Tract Infection Model in BALB/c Mice

Female BALB/c mice (20-22 g) ordered from Envigo are acclimated tohousing conditions and handled in accordance with Animal Use Protocol(AUP) number TP-08. Animals are fed irradiated Teklad Global 29 18Rodent Diet and water ad libitum. Mice are housed 6/cage in static cageswith irradiated ⅛″ Teklad corn cobbedding 7902 inside bioBubble® cleanrooms that provide H.E.P.A filtered air into the bubble environment at100 complete air changes per hour. The environment is controlled to atemperature range of 74°±4° F. and a humidity range of 30-70%. Allprocedures carried out in this experiment are conducted in compliancewith the laws, regulations, and guidelines of the National Institutes ofHealth and with the approval of the TransPharm Preclinical SolutionsAnimal Care and Use Committee.

A clinical isolate of Escherichia coli (strain CFT073, TPPS 1041) areprocured from the University of Michigan.

The organism is grown overnight at 37° C. in ambient atmosphere ontrypticase soy agar plates supplemented with 5% sheep blood cells. Theculture is aseptically swabbed and transferred to tubes of trypticasesoy broth. The optical density is determined at 600 nm. The culture isdiluted to provide an inoculum of approximately 7.5 log₁₀ CFU per mousein a volume of 30 μL. Instillation of the bacterial challengeconstituted time 0 hour for the study. Inoculum counts are estimatedbefore inoculation by optical density and confirmed after inoculation bydilution and back counts.

One hour prior to bacterial challenge, water is removed from animalcages. On Day 0 at 0 hours, mice are anesthetized using isoflurane andurine is expressed from the bladder by applying gentle pressure to theabdomen with the thumb. Mice are infected with bacteria viatransurethral injection in a volume of 30 μL. Water is returned to thecages immediately following the challenge. Challenge is performed in aBL2 surgical suite. The final count of the challenge inoculumdemonstrated a delivered burden of 7.8 log₁₀ organisms per mouse.

Nu-8 (Test article) is prepared immediately before each dosing. Nu-8 isdissolved in sterile saline and adjusted to pH 3.5 with phosphoric acid.At 23 hours post-challenge, water is removed from animal cages. One hourlater, mice are anesthetized using isoflurane and residual urine isexpressed from the bladder. Mice are treated with test article orcontrols via transurethral dosing in a volume of 30 μL according toTABLE 7 (showing Animal Challenge and Treatment Schedule). Harvest timeis the time when the mice organs are processed. All treatments areadministered in a BSL2 surgical suite. Immediately following treatmentadministration, the urethral opening is occluded using a cyanoacrylatetissue ad.

TABLE 7 Challenge Treatment E. Dose Dose Harvest Grp N Coli ROADescription ROA (mg/kg) Time Time^(a) 1 6 7.5 Transurethral Saline pHTransurethral NA 24 hr 60 min log₁₀ 3.5 2 Gentamicin 50 60 min 3 Nu-8 pH3.5 1025 20 min 4 Nu-8 pH 3.5 1025 60 min ^(a)Relative to challenge at 0hour

The primary endpoint used to assess progress of the infection is meanbacterial burden per gram of urinary bladder tissue. At 60 or 20 minutesfollowing treatment administration and urethral occlusion, mice areeuthanized by CO₂ asphyxiation. The urinary bladder is asepticallyremoved, weighed, and homogenized in 1 mL TSB using a mini bead-beater.The resulting homogenate is serially diluted (neat to 10-7) and grownovernight at ° C. on ambient atmosphere trypticase soy agar platessupplemented with 5% sheep blood cells. Colony forming units (CFU) areenumerated and the total bacterial burden per gram of urinary bladdertissue homogenate is calculated.

The geometric mean CFU, along with standard error of the mean (SEM), arecalculated using Microsoft Excel and bar charts are prepared for thedata using GraphPad Prism v. 7.0. Statistical comparisons are madebetween groups by comparing the geometric mean bacterial burden ofdifferent treatment groups in Excel, using a Student's t-test assumingunequal variance. Two-tailed P-values ≤0.05 are considered significant.

At 60 minutes post-treatment, vehicle-treated mice in Group 1demonstrated an average bladder CFU burden of 5.3 log₁₀, whilegentamicin-treated animals in Group 2 showed 6.1 log₁₀ CFU. At 20minutes post-treatment, mice treated with Nu-8 showed a significantdecrease in mean bladder CFU burden (2.9 log₁₀) when compared to thevehicle-treated control group. At 60 minutes, these mice showed a burdenof 3.7 log₁₀ CFU.

In summary, Nu-8 showed a statistically significant decrease in E. coliin animal bladders in 20 minutes post-treatment, which confirms Nu-8 iseffective against E. Coli in a urinary tract infection animal model.These results are a predictive model for human therapies.

Example 10 Confirmatory Efficacy Evaluation of Nu-8 Against EscherichiaColi in a Urinary Tract Infection Model in BALB/c Mice

Female BALB/c mice (20-22 g) ordered from Envigo are acclimated tohousing conditions and handled in accordance with Animal Use Protocol(AUP) number TP-08. Animals are fed irradiated Teklad Global 29 18Rodent Diet and water ad libitum. Mice are housed 6/cage in static cageswith irradiated ⅛″ Teklad corn cobbedding 7902 inside bioBubble® cleanrooms that provide H.E.P.A filtered air into the bubble environment at100 complete air changes per hour. The environment is controlled to atemperature range of 74°±4° F. and a humidity range of 30-70%. Allprocedures carried out in this experiment are conducted in compliancewith the laws, regulations, and guidelines of the National Institutes ofHealth and with the approval of the TransPharm Preclinical SolutionsAnimal Care and Use Committee.

A clinical isolate of Escherichia coli (strain CFT073, TPPS 1041) areprocured from the University of Michigan.

The organism is grown overnight at 37° C. in ambient atmosphere ontrypticase soy agar plates supplemented with 5% sheep blood cells. Theculture is aseptically swabbed and transferred to tubes of trypticasesoy broth. The optical density is determined at 600 nm. The culture isdiluted to provide an inoculum of approximately 7.5 log₁₀ CFU per mousein a volume of 30 μL. Instillation of the bacterial challengeconstituted time 0 hour for the study. Inoculum counts are estimatedbefore inoculation by optical density and confirmed after inoculation bydilution and back counts.

One hour prior to bacterial challenge, water is removed from animalcages. On Day 0 at 0 hours, mice are anesthetized using isoflurane andurine is expressed from the bladder by applying gentle pressure to theabdomen with the thumb. Mice are infected with bacteria viatransurethral injection in a volume of 30 μL. Water is returned to thecages immediately following the challenge. Challenge is performed in aBL2 surgical suite. The final count of the challenge inoculumdemonstrated a delivered burden of 7.8 log₁₀ organisms per mouse.

Nu-8 (Test article) is prepared immediately before each dosing. Nu-8 isdissolved in sterile saline and adjusted to pH 3.5 with phosphoric acid.At 23 hours post-challenge, water is removed from animal cages. One hourlater, mice are anesthetized using isoflurane and residual urine isexpressed from the bladder. Mice are treated with test article orcontrols via transurethral dosing in a volume of 30 μL according toTABLE 8 (showing Animal Challenge and Treatment Schedule). Alltreatments are administered in a BSL2 surgical suite.

Immediately following treatment administration, the urethral opening isoccluded using Locktite gel superglue. One drop of glue is placed at theurethral opening and the opening is held together for 5-10 seconds usingtissue forceps to ensure the urethral opening is occluded and theadhesive is dry. Animals remained under anesthetic following urethralocclusion. Mice are rotated (front to back) every 5 minutes while underanesthesia.

TABLE 8 Challenge Treatment E. Dose Dose Harvest Grp N Coli ROADescription ROA (mg/kg) Time Time^(a) 1 6 7.5 Transurethral PBS pH 3.5Transurethral NA 24 hr 20 min 2 log₁₀ Nu-8 pH 3.5 205 20 min 3 Nu-8 pH3.5 410 20 min 4 Nu-8 pH 3.5 820 10 min 5 Nu-8 pH 3.5 820 20 min^(a)Relative to challenge at 0 hour

The primary endpoint used to assess progress of the infection is meanbacterial burden per gram of urinary bladder tissue. At 10 or 20 minutesfollowing treatment administration and urethral occlusion, mice areeuthanized by CO₂ asphyxiation. The abdominal cavity is dissected toexpose the bladder and the urethra is clamped near the bladder toprevent urine leakage. Care is taken not to express urine from thebladder during removal by cutting the urethra distal to the lamp. Thebladder (with urine) is aseptically removed and transferred to apre-weighed vial with 1 mL TSB. The bladder is then cut to release urineinto the vial along with the tissue. The tissue is weighed andhomogenized using a mini-bead beater. The resulting homogenate isserially diluted (neat to 10-7), plated in 5 μL duplicate spots, andgrown overnight at 37° C. in ambient atmosphere on trypticase soy agarplates supplemented with 5% sheep blood cells. The undiluted (neat)homogenate is also plated in 100 μL volume for each sample. Colonyforming units (CFU) are enumerated and the total bacterial burden pergram of urinary bladder tissue homogenate is calculated.

The geometric mean CFU, along with standard error of the mean (SEM), arecalculated using Microsoft Excel, and bar charts are prepared for thedata using GraphPad Prism v.7.0. Statistical comparisons are madebetween groups by comparing the geometric mean bacterial burden ofdifferent treatment groups in Excel, using a Student's t-test assumingunequal variance. Two-tailed P-values ≤0.05 are considered significant.

At 10 minutes post-treatment, animals treated with 820 mg/kg Nu-8 showedan average bladder CFU burden of 6.3 log 10.

At 20 minutes post-treatment, vehicle-treated mice in Group 1demonstrated an average of 6.8 log 10 CFU/g tissue. Mice which receivedNu-8 at 205, 410, and 820 mg/kg showed bacterial burdens of 6.5, 5.0,and 5.4 log 10, respectively.

In summary, Nu-8 showed a decrease in E. coli in animal bladders in 20minutes post-treatment, which confirms Nu-8 is effective against E. Coliin a urinary tract infection animal model. These results are apredictive model for human therapies.

Example 11 Urinary Tract Infection (UTI) Model in Rats Induced byEscherichia coli with Transurethral Treatment

Female Sprague-Dawley rats (n=6/group) are intraurethrally infected withthe predetermined inoculum size of E. coli. At the specified timefollowing infection with (depending on the in vivo growth curve), theanimals are anaesthetized (ketamine/xylazine) and treated bytransurethral administration with neutral saline (group 1), saline pH3.5 adjusted with phosphoric acid (group 2), test compound Nu-8 pH 3.5at 103 and 207 mg/kg (groups 3 and 4, respectively). When adjusting pH,the volume of phosphoric acid added are monitored and the finalconcentration of the pH adjusted dose solution are subsequentlydetermined. The goal is to have the final concentration after pHadjustment within 10% of the desired dose so the final concentrationafter pH adjustment are reported. Volume of administration will be 300μL. TABLE 9 (Animal Challenge and Treatment Schedule) summarizes thestudy groups.

TABLE 9 Terminal procedures Treatment (urine Inoculum size 4 hrs postsampling CFU/300 μL/rat 2nd infection directly Group (E. coli ATCC25922)(300 μL from No N 1^(st) Infection 2^(nd) Infection intraurethrally)bladder) 1 10 1 × 10⁸ 1 × 10⁸ Control saline 60 minutes neutral pH post2 10 Control saline treatment pH 3.5 3 10 Nu-8 pH 3.5; 103 mg/kg 4 10Nu-8 pH 3.5; 207 mg/kg

Two hours prior to each infection animals are water deprived. Eachanimal is infected twice with 24 hrs difference by transurethraladministration of 300 μL of bacterial suspension under light ketamineand xylazine anaesthesia. Prior to infection, urine is evacuated bydigital pressure, cannula is gently inserted into the bladder viaurethra, and 300 μL of bacterial suspension is inserted into thebladder. After infection cannula is gently removed, the animal is heldin upside down position for 1 min, then placed into a cage.

Animals from all groups are sacrificed by exsanguination on K2EDTAanticoagulant (under ketamine/xylazine anaesthesia) 60 minutes followingtreatment, and urine are sampled under sterile conditions for CFUdetermination.

The mean CFU log 10 per mL of bladder tissue (tissue plus urine) pergroup was 5.67, 5.53 and 4.60 Log 10 CFUs/mL bladder tissue for pH 3.5solutions of saline, and Nu-8 doses of 103 mg/kg and 207 mg/kg at 60min, respectively. The Log 10 CFUs/mL bladder tissue for saline controlat pH 7 was 5.51. Statistically significant reduction in CFU counts isobserved in group treated with Nu-8 at a dose of 207 mg/kg BW ascompared to saline pH3.5 control group. There is no statisticallysignificant difference in CFU counts between groups treated with Nu-8and saline pH 7 control group.

In summary, this rat study confirms the mouse studies shown in inEXAMPLES 9 and 10, all of which demonstrate that Nu-8 shows astatistically significant decrease in E. coli in animal bladders in 20minutes post-treatment. The results of this study again confirms thatNu-8 is effective against E. Coli in a urinary tract infection animalmodel. These results are a predictive model for human therapies.

Example 12 Nu-8 Treatment of Human Patient Having Complicated UrinaryTract Infection

A human patient is identified as having a complicated urinary tractinfection. A pharmaceutical composition in the form of a liquid solutioncontaining an effective amount of Nu-8 is administered intravesically tothe patient via a catheter. The patient is monitored until symptoms arealleviated or ameliorated, and the pharmaceutical composition may beadministered one or more additional times if it is determined that suchadministration is necessary or helpful for treatment.

Example 13 Nu-8 Treatment of Human Patient Having a Lung InfectionArising from Cystic Fibrosis

A human patient is identified as having a lung infection arising fromcystic fibrosis. A pharmaceutical composition in the form of a liquidsolution containing an effective amount of Nu-8 is administeredinhalationally to the patient via a nebulizer. The patient is monitoreduntil symptoms are alleviated or ameliorated, and the pharmaceuticalcomposition may be administered one or more additional times if it isdetermined that such administration is necessary or helpful fortreatment.

Example 14 Nu-8 Treatment of Human Patient Having an Infection of aDiabetic Foot Ulcer

A human patient is identified as having a diabetic foot ulcer. Apharmaceutical composition in the form of a gel containing an effectiveamount of Nu-8 is administered topically to the patient at the locationof the diabetic foot ulcer. The patient is monitored until symptoms arealleviated or ameliorated, and the pharmaceutical composition may beadministered one or more additional times if it is determined that suchadministration is necessary or helpful for treatment.

Example 15 Nu-8 Treatment of Human Patient Having Ventilator AcquiredPneumonia

A human patient is identified as having ventilator acquired pneumonia. Apharmaceutical composition in the form of a liquid solution containingan effective amount of Nu-8 is administered inhalationally to thepatient via a nebulizer. The patient is monitored until symptoms arealleviated or ameliorated, and the pharmaceutical composition may beadministered one or more additional times if it is determined that suchadministration is necessary or helpful for treatment.

Example 16 Nu-8 Treatment of Human Patient Having an Infection in a BurnWound

A human patient is identified as having an infection in a burn wound. Apharmaceutical composition in the form of a gel containing an effectiveamount of Nu-8 is administered topically to the patient at the locationof the burn wound. The patient is monitored until symptoms arealleviated or ameliorated, and the pharmaceutical composition may beadministered one or more additional times if it is determined that suchadministration is necessary or helpful for treatment.

Example 17 Nu-8 Treatment of Human Patient Having Impetigo

A human patient is identified as having impetigo. A pharmaceuticalcomposition in the form of a gel containing an effective amount of Nu-8is administered topically to the patient at the location of thevesicles, pustules and/or yellowish crusts. The patient is monitoreduntil symptoms are alleviated or ameliorated, and the pharmaceuticalcomposition may be administered one or more additional times if it isdetermined that such administration is necessary or helpful fortreatment.

Example 18 Nu-8 Treatment of Human Patient Having Otitis Externa

A human patient is identified as having otitis externa. A pharmaceuticalcomposition in the form of a liquid solution containing an effectiveamount of Nu-8 is administered topically directly into the patient'sexternal ear canal. The patient is monitored until symptoms arealleviated or ameliorated, and the pharmaceutical composition may beadministered one or more additional times if it is determined that suchadministration is necessary or helpful for treatment.

Example 19 Nu-8 Treatment of Female Human Patient Having BacterialVaginosis

A female human patient is identified as having bacterial vaginosis. Apharmaceutical composition in the form of a gel containing an effectiveamount of Nu-8 is administered topically onto or into the patient'svagina. The patient is monitored until symptoms are alleviated orameliorated, and the pharmaceutical composition may be administered oneor more additional times if it is determined that such administration isnecessary or helpful for treatment.

Example 20 Nu-8 Treatment of Human Patient Having an Infection of anUlcer

A human patient is identified as having an ulcer. A pharmaceuticalcomposition in the form of a gel containing an effective amount of Nu-8is administered topically to the patient at the location of the ulcer.The patient is monitored until symptoms are alleviated or ameliorated,and the pharmaceutical composition may be administered one or moreadditional times if it is determined that such administration isnecessary or helpful for treatment.

Example 21 Nu-8 Treatment of Human Patient Having an Infection in aWound

A human patient is identified as having an infection in a wound. Apharmaceutical composition in the form of a gel containing an effectiveamount of Nu-8 is administered topically to the patient at the locationof the wound. The patient is monitored until symptoms are alleviated orameliorated, and the pharmaceutical composition may be administered oneor more additional times if it is determined that such administration isnecessary or helpful for treatment.

Example 22 Efficacy Evaluation of Nu-8 Formulated in Saline Solution orHydrogel Against Staphylococcus aureus in a Murine Dermal InfectionModel

Introduction

SKH-1 hairless mice have the outer layer of skin cells removed bystripping with 7 applications and removals of surgical tape. Immediatelyfollowing tape stripping, mice receive a topical inoculation ofmethicillin resistant Staphylococcus aureus (USA300) at a targetedchallenge of 6.0 log₁₀ CFU. Four hours following challenge, mice aretreated with test articles or vehicle controls, and at two hoursfollowing treatment, mice have skin harvested for CFU burdenenumeration.

Skin Preparation

SKH-1 mice are obtained from Charles River Laboratories. The age of themice on Day 0 is approximately 6-8 weeks. Only female mice are selectedfor the study. Animals are handled in accordance with AUP number TP-18.Mice are housed in solid-bottom micro-isolator cages on stainless steelracks. Animals are fed irradiated Teklad Global 2918 Rodent Diet andwater ad libitum. Bedding is provided in the form of irradiated Teklad⅛″ corn cob bedding 7902. Animals are maintained in a bioBubble® CleanRoom which provides H.E.P.A filtered air into the bubble environment at100 complete air changes per hour. The environment is controlled to atemperature range of 74°±5° F. and a humidity range of 30-70%.Fluorescent lighting provides illumination for 12 hours per day. Miceare acclimated for a minimum of 24 hours prior to study start. Theanimals are observed for general health and acceptability for use inthis study. Only animals deemed healthy are included in this study.

On Day 0 immediately prior to infection, each mouse is anesthetizedusing isoflurane and the dorsal area receives 7 applications andremovals of Nexcare™ (3M) surgical tape in order to remove the outermostepidermal layer of skin.

Challenge

The challenge microorganimsm is prepared. Methicillin resistantStaphylococcus aureus (USA300) is grown overnight at 37° C. at ambientatmosphere trypticase soy agar plates supplemented with 5% sheep bloodcells. The culture is aseptically swabbed and transferred to tubessterile water until optical density reaches approximately 0.75 at 600nm. The cultures are diluted to provide challenge inoculate of 6.0 log₁₀CFU per mouse in a volume of 100 μL. Inoculum count is estimated beforeinoculation by optical density and confirmed after inoculation bydilution and back count.

As mentioned above, the final count of the challenge inoculumdemonstrates a delivered burden of 6.0 log₁₀ organisms per mouse. On Day0 at 0 hours, animals are anesthetized using isoflurane, brought to asurgical plane, and infected with bacteria via topical application,spread in the tape stripped area of approximately 0.75″×0.75″. Challengeis allowed to dry slightly before mice are brought out of anesthesia.

Formulation and Dosing

The test articles are prepared in a manner to minimize endotoxin andbacterial contamination. A 10% (100 mg/mL) solution of Nu-8 is preparedin 0.9% sterile saline. A 20% Nu-8 solution for 50/50 mixture in ahydrogel vehicle (for 10% final Nu-8 concentration) is made usingsterile water. Citric acid is used to adjust the solutions to pH 3.5.The test articles are stored at 4° C.

A 0.9% sterile saline adjusted to pH 3.5 with citric acid is prepared asa vehicle/negative control and stored at room temperature. A hydrogelvehicle adjusted to pH 3.5 with citric acid is prepared as anothervehicle/negative control. The hydrogel vehicle is prepared by mixingequal volumes of hydrogel and 0.9% sterile saline with final pH of themixture adjusted to pH 3.5.

At exactly four hours following challenge, mice in Groups 2-5 receive atopical application of Nu-8 (in either saline or hydrogel vehicle),saline vehicle, or gel vehicle, in a volume of 100 spread on the dorsalarea previously stripped and inoculated with bacteria. Mice in Group 1do not receive treatment. Mice are housed individually followingtreatment until harvest time.

Endpoint Analysis

Mice are observed at least twice daily during the study period and arerandomly assigned to experimental groups as shown in TABLE 10. At thetime indicated in TABLE 10, mice are humanely euthanized via CO₂overexposure. Mice are harvested at 6 hours post challenge (2 hourspost-treatment).

Following euthanasia, a section of excised skin approximately 0.5″×0.5″is aseptically removed from the infected/treated area and transferred tovials with 2.0 mL of sterile water and weighed. Tissues are allowed toset at room temperature for 10 minutes. Tissue pH is measured usinglitmus paper and recorded. All tissues have pH of 5.0 or 5.5. FollowingpH measurement, tissues are homogenized using a bead beater. Thehomogenate is serially diluted from neat to 10⁻⁷ and plated in duplicate5 μL spots onto trypticase soy agar plates supplemented with 5% sheepblood cells. 100 μL of the undiluted (neat) homogenate is plated foreach sample. Plates are incubated overnight at 37° C. in ambientatmosphere. Colony forming units (CFU) are tabulated for each treatmentper gram of skin tissue and efficacy is determined by comparison to thevehicle matched controls.

TABLE 10 USA300 Challenge log₁₀ Topical Treatment Skin Group CFU RouteDescription Schedule^(a) Harvest^(a) 1 6.0 Topical Untreated NA 6 hr 26.0 Topical Saline Vehicle 4 hr 6 hr (pH 3.5) 3 6.0 Topical HydrogelControl 4 hr 6 hr (pH 3.5) 4 6.0 Topical Nu-8 10% Solution 4 hr 6 hr (pH3.5) 5 6.0 Topical Hydrogel 10% Nu-8 4 hr 6 hr mixture (pH 3.5)^(a)Treatment and Harvest times are relative to challenge time of 0 hrInfection/Treatment/General Observations

None of the study subjects displayed any acute adverse events associatedwith the treatments. None of the test subjects succumbed to theinfection or showed signs of morbidity, which could be attributed topenetration of the infection into the circulatory system or deep tissue.No groups displayed adverse signs beyond those expected for mice whichhave received a superficial dermal bacterial infection.

The untreated group CFU burden was 6.8 log₁₀ at 6 hours post challenge.The saline (pH 3.5) CFU burden was 6.5 log₁₀ at 6 hours post challenge.The hydrogel vehicle (pH 3.5) was 6.4 log₁₀ at 6 hours post challenge.At 6 hours post challenge, both Nu-8 groups (in saline and hydrogel)showed a significant decrease in CFU burden (˜1.0 log₁₀ reduction).

Referring now to FIG. 1, the bar graph shows a significant reduction incolony forming units (CFU) at two hours post treatment when comparingthe saline and gel controls (column one) taken as baseline infection atapproximately 300,000 CFU per square millimeter to either the Nu-8 insaline treated mice at approximately 30,000 CFU per square millimeter orthe Nu-8 hydrogel treated mice at approximately 40,000 CFU per squaremillimeter, which is approximately a ten-fold reduction in bacteria.

Referring now to FIG. 2, the bar graph shows the same information asFIG. 1, except that the data (numbers of CFUs) are presented as log₁₀numbers as explained below.

One of the core starting requirements, when designing infectious modelsto test anti-microbial therapeutics is selecting the targeted reductionof colony forming units (CFU) of the targeted microbe. Log reduction isa mathematical term that is used to express the relative number ofliving microbes that are eliminated by anti-microbial agents. In termsof infection control, “Log Reductions” convey how effective a product isat reducing pathogens. The greater the log reduction the more effectivethe product is at killing bacteria and other pathogens that can causeinfections. It is not necessary to convert the CFU value to log value;however, changing the numbers to the logarithm makes it easier to seesmall numbers and large numbers on the same graph and to facilitatestatistical analysis. For example, a 1 log reduction corresponds toinactivating 90 percent of a target microbe. The relationship betweenlog reduction and percent reduction are as listed below:

1 log reduction=90% reduction

2 log reduction=99% reduction

3 log reduction=99.9% reduction

4 log reduction=99.99% reduction

5 log reduction=99.999% reduction

6 log reduction=99.9999% reduction

Referring now to FIG. 3, the bar graph shows the same information asFIG. 1, except that the data (numbers of CFUs) are presented aspercentages. The saline/gel controls (column one) are taken as 100%infection level of the mouse wounds and the Nu-8 saline (column 2) orNu-8 gel (column 3) are shown as a percentage reduction (90% Nu-8 salineand 87% Nu-8 gel) compared to the controls.

Together, these data demonstrate that Staphylococcus aureus establishesa robust dermal infection. When compared to hydrogel and saline treatedcontrols, topical administration of Nu-8 in hydrogel or sterile salinesignificantly decreased bacterial burden at 6 hours post-challenge.

While embodiments have been disclosed hereinabove, the present inventionis not limited to the disclosed embodiments. Instead, this applicationis intended to cover any variations, uses, or adaptations of theinvention using its general principles. Further, this application isintended to cover such departures from the present disclosure as comewithin known or customary practice in the art to which this inventionpertains and which fall within the limits of the appended claims.

What is claimed is:
 1. A method of treating an infection of at least one of a wound or an ulcer in a patient in need thereof, the method comprising administering to the patient an effective amount of a compound having the formula:

or a pharmaceutically acceptable salt thereof.
 2. The method of claim 1, wherein the administration is topical administration.
 3. The method of claim 1, wherein the administration is carried out using the compound, or a pharmaceutically acceptable salt thereof, in a lotion, paste, gel, cream, ointment, oil, or other viscous composition.
 4. The method of claim 1, wherein the administration is carried out using the compound, or a pharmaceutically acceptable salt thereof, in a powder, solution, or suspension.
 5. The method of claim 1, wherein the patient is administered at least one additional active ingredient.
 6. The method of claim 1, wherein the administration is carried out as a multiple dose regimen.
 7. The method of claim 6, wherein the multiple dose regimen is a time period of up to about 7 days.
 8. The method of claim 6, wherein the multiple dose regimen is a time period of up to about 14 days.
 9. The method of claim 6, wherein the multiple dose regimen is a time period of up to about 21 days or up to about one month.
 10. The method of claim 1, wherein the administration is carried out as a chronic treatment regimen.
 11. The method of claim 1, wherein the administration is carried out one or more times per day.
 12. The method of claim 1, wherein the amount of the compound, or a pharmaceutically acceptable salt thereof, administered to the patient is from about 0.1 to about 1000 milligram (mg) of the compound, or a pharmaceutically acceptable salt thereof, per kilogram (kg) of patient body weight.
 13. The method of claim 1, wherein the amount of the compound, or a pharmaceutically acceptable salt thereof, administered to the patient is from about 0.1 to about 500 mg of the compound, or a pharmaceutically acceptable salt thereof, per kg of patient body weight.
 14. The method of claim 1, wherein the amount of the compound, or a pharmaceutically acceptable salt thereof, administered to the patient is from about 0.1 to about 300 mg of the compound, or a pharmaceutically acceptable salt thereof, per kg of patient body weight.
 15. The method of claim 1, wherein the amount of the compound, or a pharmaceutically acceptable salt thereof, administered to the patient is from about 0.1 to about 200 mg of the compound, or a pharmaceutically acceptable salt thereof, per kg of patient body weight.
 16. The method of claim 1, wherein the amount of the compound, or a pharmaceutically acceptable salt thereof, administered to the patient is from about 0.1 to about 100 mg of the compound, or a pharmaceutically acceptable salt thereof, per kg of patient body weight.
 17. The method of claim 1, wherein the patient is a human.
 18. The method of claim 1, wherein the pharmaceutically acceptable salt is a sodium salt.
 19. The method of claim 18, wherein the sodium salt is sodium ((2R,3S,5R)-5-(4-amino-2-oxopyrimidin-1(2H)-yl)-3-((butoxyoxidophosphor-yl)oxy)tetrahydrofuran-2-yl)methyl butyl phosphate.
 20. The method of claim 1, wherein the wound is a burn wound.
 21. The method of claim 1, wherein the ulcer is a diabetic foot ulcer. 